The Great Pneumonic Plague of 1910-1911

The Great Manchurian Plague of 1910-1911: Geopolitics of an Epidemic Disease

by William C. Summers
Yale U Press, 2012

Manchuria was a political mess at the turn of the 20th century. Although it was the homeland of the Qing dynasty, the Chinese considered it a backwater. Japan and Russia on the other hand saw it as potential colonial territory, a beachhead for Japan’s mainland ambitions or access to a valuable ice-free Pacific port for Russia. By 1910 an uneasy truce held giving Russia and Japan corridors to build railroads with stations and towns to support them while technically still in Chinese sovereign territory. The importance of Manchuria to global politics and trade was underscored by the presence of European and American diplomatic representatives in these upstart towns and ports. Into this delicate situation, the discovery that marmot fur could be dyed to pass as ermine brought a flood of primarily Chinese hunters into the region. The drive for furs (and marmot oil) led many to cast aside traditional hunting practices and safeguards, setting the stage for the plague to come.

The beginning of the plague was sparsely recorded. Starting in October 1910 scattered reports were sent that plague had appeared at sites along the railway, but concern was slow in coming. Summers credits the nearly annual outbreaks of plague, low concern for locals, and the temporary camps of hunters for the lack of information on beginning of the plague. Deaths quickly jumped into the thousands in towns along the rail line but never spread very far from the lines. Summers notes that of the over 43,000 recorded cases during the outbreak only one single person survived (p. 19). Some estimates place the mortality closer to 60,000 when early cases and locals away from the rail line are included. Summers notes that this puts the death toll in the range of the great London plague of 1665. By February 1911, the plague was over; blatant proof the plague outbreaks can flourish in winter (as it sometimes did in medieval European winters).

This plague has some unique features. First, there is no report of bubonic plague at all; it was exclusively pneumonic. Most plagues are primarily bubonic with flair ups of pneumonic transmission. Etiology was confirmed by autopsy and the then new bacteriological techniques including culture. American doctor Richard Strong, working with the Chinese under Wu Lien-Teh, did 25 autopsies before the International Plague Conference called by the Chinese in Mukden. There is no doubt the Yersinia pestis caused this epidemic.

Without antibiotics, quarantine and isolation were the only effective means of control. The means were brutal but effective. In the Russian zone the Chinese were crowded into train cars and not let out until there were several days with no one displaying any symptoms. If a case of pneumonic plague was locked in the car with others, the prognosis for the others was predictably terrible. Within this relatively small region, we can also see three different national approaches (China, Russia, and Japan) to controlling the epidemic each always subordinated to their respective political anxieties.

The chapter on origins of the plague begins to move toward was Edmund Russell envisioned as evolutionary history in his book of the same name (2011). The most useful information here is the history of marmot activity and traditional hunting. Summers hypothesizes that traditional shaman-like practices may have aided hunters in only taking healthy animals. Concern for the health of the animal was one of the early traditions abandoned by hunters eager for furs. Following the reports of the time, Summers believes the plague originated in the marmots, and was distinct from the third pandemic lineage. In accordance with modern strain maps, Summers predicts that the 1910-1911 Manchurian outbreak strain will belong to either the antiqua or medievalis biovars (p. 128-9). If this is true, as is likely, it’s a relatively modern challenge to our notion that plague during pandemics has a single lineage and origin. It should be possible to type this outbreak from graves of the epidemic (which should be relatively easy to locate at barely a century old) or even tissue archived from the autopsies (if it was saved and can be located).

Summers is clearly in his element when he discusses the politics of turn of the 20th century politics. This is a region and time period that most Americans know very little about but is still critically important for Asian politics today with the still uneasy relationship between China, Korea, Japan, and Russia. Summers account lays out the different approaches to healthcare and attitudes toward the epidemic as a national and economic threat. This carried over to the International Plague Conference that nevertheless managed to focus on science and medicine. While the scientific politics was interesting I would have liked to hear more about the contents of the wide-ranging Conference report.

Summers does a good job of being very diplomatic will all parties concerned. In doing so, he does overlook a major legacy of the Manchurian plague. There seems little doubt that this plague, witnessed and closely reported on by Russia, the United States and Japan, played a role in plague being developed as a biological weapon. This plague illustrated the deadly efficiency and sustained transmission of pneumonic plague. This book should be read as a prologue to Japan’s biological ‘experiments’ during World War II beginning in Manchuria (see Sheldon Harris’ Factories of Death) and the continuing programs of the United States and Russia during the Cold War.

This book makes a valuable contribution to plague studies, and early 20th century public health practices. Yet there are still unanswered questions on genetics, epidemiology, and ecology. I hope this book along with Myron Eschenberg’s Plague Ports(2007) and others are ushering in a new period of focus on the plague in the 19th-20th century.

Opening the Plague Files

Book Citation: A.P. Cook & N.D. Cook.  The Plague Files: Crisis Management in Sixteenth-Century Seville.  Louisiana State University Press, 2009. 296 pp. ISBN: 978-0-8071-4360-5.

Topic:
Public Health Crisis Management

Time and Place:
Seville, Spanish Empire, 1579-1581.

Audience: 

Those interested in history, crisis management, public health, and political science; written for a general audience.

Discussion:

The Plague Files is an intensive history of the daily challenges and crises dealt with by the royal governor and city council of Seville from 1579 to 1582.  As its title implies, this book is about crisis management and it stays true to this focus. Seville was faced with two very different pandemics, influenza and plague, within the same year compounded by food shortages, economic pressures, response funding difficulties, response fatigue, and the potential of civil unrest. If you ever wondered what it would be like for plague and an influenza pandemic to go (sequentially) head to head in the same population, Seville in 1579-1580 is your ideal test population.  The challenges and limitations of both quarantine and a cordon sanitaire are highlighted throughout the book.

I was impressed by their case investigation and surveillance system.Workers were contracted and paid based on their service, so detailed reports were filed to justify their pay from the plague commission. Using these reports, the authors were able to trace the detailed steps of case investigators as they tracked exposed people and textiles that they viewed as contagious. Dispatched surveillance officers also had to file detailed reports of their efforts and findings to draw their pay. The Count of Villar, the royal governor, handed out penalties including jail time for officials and others who were deemed negligent in their duties.

It was fascinating to see how their concepts of contagion played into their public health response. Textiles were the gravest concern for controlling plague contagion inside the city walls. The trail of dead owners of some clothing or bedding seems to justify their concern. Yet, there is no evidence of personal protective equipment/behavior or concern over grain storage. On the other hand, the city was on the verge of starvation much of the time so they couldn’t be very choosy about grain shipment or storage. Physicians were advisers to the Plague Council but not central to the decision-making process. Most were hired to work for the duration of the plague, often one per hospital or outlying village. The Plague Council was primarily concerned with controlling movements of people, and  providing and paying for the poor and destitute who they knew were kindling for an explosive outbreak. Diagnosis was the physicians most useful duty to the plague council. Plague diagnoses were complicated by concurrent outbreaks of influenza, typhus, other ‘common fevers’ (possibly malaria), and malnutrition. There is no doubt that the plague with all its classic symptoms was the primary pathogen.

One of my take home lessons from The Plague Files is how long and relentless a plague outbreak could be. Response fatigue was a critical problem for everyone. People just get tired of the restrictions and become conditioned to the steadiness of death. Unlike the short, sharp influenza mortality, plague deaths often trickled in at less than ten per week for months punctuated by spikes of death.

Historical  & Scientific Content:

This microhistory draws almost entirely  from a cache of primary source documents in Seville’s Municipal Archive. Surprisingly, quotes from these documents are very short. The focus on Seville is so intense context is often lacking.

The science is anecdotal and kept at the level of sixteenth century understanding. They don’t apply modern understanding of plague or influenza.  Medical treatment is discussed vaguely; few specific treatments are detailed. For example, the council paid for apothecaries to stock and provide plague medicines but the authors didn’t discuss what they stocked or if they had difficulty obtaining medicines. It appears that there was no standard treatment or medication used in the region. They don’t make an effort to accumulate data or do any standard epidemiological analysis. By the end of the book I was craving some data. The volume of anecdotal evidence does provide plenty of evidence that diagnosis was not very secure for many individuals complicating data classification.  Historical epidemiologists will have to cope with other concurrent diseases, significant for plague outbreaks that last months to over a year. Ironically in the case of Seville, I suspect a standard epidemiological chart of total deaths vs time would have highlighted the difference between influenza and plague.

References, Illustrations, and Usability

It has a full bibliography but minimal footnotes, mostly to primary sources. I suspect that it would be fairly difficult to look for more information based on their footnotes and access to the primary sources.  They appear to have made minimal use of the secondary sources, or at least there are very minimal footnotes to them. It does have a glossary for Spanish terms; all quotes are translated. The illustrations were okay. It could have used a few more local maps fit into the text where appropriate.

I recommend this book primarily for biosecurity and crisis managers. Its usefulness to the sciences and humanities is primarily for anecdotal information.

Japanese Use of Plague during World War II

I’ve been reading Sheldon Harris’ Factories of Death: Japanese Biological Warfare, 1932-1945, and the American Cover-up. (Rev. ed, 2002), considered the definitive book on biological warfare in the Pacific theater during WWII. My primary interest is in Japanese research and use of plague in their biological warfare program.  Since this blog is, in part, a research tool, this post is a collection of notes taken specifically on plague, though the book covers a much wider program. If you ever wondered why plague is a category A bioterrorism agent, what follows will go a long way in explaining.

Lt. Gen. Shiro Ishii (1892-1959) of Unit 731, the biological warfare unit of Imperial Japan.

Lt. Gen. Shiro Ishii was the primary organizer, promoter and director of the Japanese biological warfare (BW) program. He was involved at all levels from pitch-man to the Japanese military and academia to personally supervising research on human subjects. He began his work research in the potential of biological weapons in the late 1920s.

One of Ishii’s first facilities was called the Zhong Ma Castle in Beiyinhe northern Manchuria. Initially their test subjects were trouble makers among the Chinese population: criminals, communists, and other suspicious persons. Ishii began by focusing on plague, glanders and anthrax. Subjects were injected with the pathogen and the course of their disease was monitored; all were extensively autopsied. (p. 33-34) There are numerous reports of autopsies being carried out on the unconscious, as in  not yet dead.

In 1939 the stressed Japanese military allowed Ishii to send several BW attacks  against Soviet forces in the Nomonhan region. Details of the mission refer to the contamination of water supplies with typhoid but plague, cholera and dysentery effected both Japanese and Soviet troops during the campaign. Harris is unclear whether these were effects of biological weapons operations or naturally occurring outbreaks. (p. 97-98) In 1942 a Soviet defector to Germany claimed that Soviet biological weapons were field tested during combat in Mongolia (/Manchuria) and that a there was a major plague epidemic at that time. (p. 98) With both sides attempting biological warfare and with the level of technology at the time, it is unlikely that it will be possible to unravel outcome of either the Japanese or Soviet efforts.  The Japanese BW program was developed primarily with a future war against the Soviets in mind, as Japan planned to take land north of Manchuria. The intent of the BW program was to give Japan an advantage over the vast population and natural resources of China and the Soviet Union.

Shiro Ishii built an extensive network of facilities in China for the purposes of research and testing. Some details of these units in respect to plague activity follows:

• Unit 731 was the primary unit under Ishii’s command based at his specially built facility at Ping Fan outside of Harbin, Manchuria. The scale of Ping Fan was enormous. Here Ishii built his dream facility complete with four boilers capable of producing one ton of  culture media each sterilized in fourteen autoclaves, ‘Ishii cultivators’ each capable of producing 30 kilograms of bacterial cell mass, and the capacity to maintain  plague, cholera, typhoid and paratyphoid, dysentery, anthrax, gas gangrene, tetnus, and glanders. Ping Fan was also equipped with the capacity to mass produce fleas and its own fleet of airplanes for experiments. (p. 69) After the war Maj. Gen. Kawaashima Kiyochi boasted that Ping Fan could produce 300 kg of plague monthly in addition to other pathogens. (p. 69)

Manchuria, today split between Russia and China. (Public domain image from the CIA’s World Fact Book via Wikipedia Commons.)

• Unit 731 conducted ‘field tests’ throughout northern and eastern China from late 1939 to 1942. They specialized in spreading pathogens by contaminated water and food. They tested cholera, typhoid, paratyphoid, and especially anthrax and plague. They were reported to start epidemics and then enter villages claiming to vaccinate against the epidemic, except that they would inject the pathogen instead. Their experiments involved introducing pathogens by unusual routes such as ‘vaccine’ injections including cholera bacteria. In a Soviet war crimes trial, testimony was given that Ishii’s forces handed out special chocolate bars laced with anthrax to Chinese school children “with unavoidable side effects”‘. (p. 99)

• Unit 731  gave special attention to plague, spreading plague infected rats widely throughout China and experimenting with spreading plague through fomites like contaminated fountain pens or canes. When a full scale epidemic broke out, Japanese soldiers would force an evacuation of the village and burn it to the ground. An American missionary Archie Crouch reported seeing Japanese plains drop odd bombs that spread what looked like wheat over the city of Ningbo and plague erupted just days later. Chinese officials tried to combat the plague with isolation, quarantine and burning the most infected part of the city but over 500 people died of plague and other agents spread by Ishii’s forces. Outbreaks of plague continued in the region of Ningbo until as late as 1959 (p. 101-103).  The city of Quzhou was also subjected to bombs that scattered, soy beans and rags contaminated with plague, cholera, typhoid and possibly anthrax. Bacteriologist Qui Mingxuan lived in the city as a child, and put the death toll for the six years after the first plague outbreak in 1940 at 50,000. Qui noted that there was no history of plague in Quzhou before 1940. (p. 102) In August 1942 plague was sprayed over the village of Congshan in the Zhejiang Province.  Rats began to die in droves two weeks later and over the next two months 392 out of 1200 residents died of bubonic plague. (p. 103) For unexplained reasons, after 1942 Unit 731 stopped large field tests and began to concentrate on more direct human experimentation in controlled environments. Harris estimates that by the end of 1942, “the casualty count in the open tests surely fell into the six figure range” (p. 104).

• Enough credible reports made their way out of China to convince the Allies that Japan was conducting biological warfare. (p. 100-103) In addition to reports coming out of China, American investigators found ampoules of cholera in Burma that locals reported where dropped from planes by the Japanese. In September 1944, Thailand also experienced a plague although there had been no recent plague activity in the area. The Thais and Americans both concluded that these outbreaks in Burma and Thailand were acts of biological warfare by Japan. (p. 226)

• The facility at Nanking, operated by Unit Ei 1644 under the direction of Tomosada Masuda, was a mass production site for bacteria (cholera, typhus, and plague), rodents and vectors. Nanking specialized in flea production for plague experiments. It was also a training site for bacteriologists to conduct biological warfare, producing about  900  from 1941-1943 (p. 142-143)

• Unit 100 in Changchun region worked on plague among other pathogens from 1940 to 1945. Although plague outbreaks had occurred in the region previously, several large suspicious outbreaks that took thousands of lives occurred from 1940 to the end of the war. Unit 100 used these outbreaks as cover for widespread experimentation on villagers.  Injecting slum dwellers with plague under the guise of vaccines against the plague was one of their notable practices. They then relocated about 5000 survivors and burned the slum to the ground. As the war was coming to a close, the order came to destroy all evidence, buildings and people. None of the test subjects or Chinese workers escaped. Some of the infected animals were released into the countryside after the official surrender possibly triggering outbreaks of plague, anthrax and glanders in 1946, 1947 and 1951. (p. 126-133)

• At the Anda test facility in northern Manchuria, Chinese test subjects were tied to open air stakes and bombs containing either an anthrax slurry or plague infected fleas were exploded around them in an attempt to infect them. There is some evidence that anthrax worked slightly better than the plague because the fleas did not handle the exploding bomb well (!). By 1944 they were working on developing means for spreading pneumonic plague and other respiratory pathogens. Fortunately, they were still unsuccessful by the end of the war. (p. 88-90) Ishii would later brag to US war dept. interrogators that he developed a porcelain bomb that successfully disseminated plague (p. 247).

At the beginning of the war, the American biological weapons program was the least developed of all the major combatants. The US military was eager to repair this deficit. American offensive and defensive biological warfare research began at Fort Detrick, Maryland, in 1942. Plague was one of many different pathogens worked on during the war. (p. 210) After the Japanese surrender, American officials were much more interested in extracting intelligence from cooperative Japanese researchers, including Shiro Ishii, than in pursuing justice for the Chinese or even American POWs that were victims of their experiments. To insure cooperation Shiro Ishii was given immunity from prosecution and no one was ever brought to the war crimes trials in Tokyo for biological warfare.  I will leave issues of justice and the cover-up to journalists and political historians.

I do have to take issue with Harris’ assertion that Shiro Ishii was a good microbiologist. He may have been a good pitch-man, organizer and military man but not necessarily a good biologist or physician.  First, I can’t accept that anyone racist enough to mentally justify this work was a competent biologist, much less a physician. Designing and carrying out these ‘experiments’ are the sign of an unstable mind. Methodologically,  ‘try absolutely everything you can think of and something might work’ is not good science, not even in wartime. Even if allied programs did similar things, it is still not good science. He thought more like an engineer than a biologist. The innovation that started his career and gained military attention was the development of a water filtration system to prevent cholera for the military. From a strategic point of view, biological weapons were incredibly risky in the 1940s before the discovery of penicillin and other effective antibiotics. The Japanese military actually had to reign them in out of fears of blow-back. Considering what the Japanese military was willing to do during World War II, this says a great deal.

Paul Slack’s Plague: A Very Short Introduction

Book Citation: Paul Slack. (2012) Plague: A Very Short Introduction. Oxford: Oxford University Press. ISBN: 978-0-19-958954-8. Pocket size paperback, 138 pages. $11.95 {#307 of Oxford’s Very Short Introduction series}

Topic: The Plague

Time and Place: Primarily Europe from c. 540- c. 1910

Audience: General audience. Intended as an introduction to the topic for anyone with a college reading level.

Discussion:

A couple of months ago I asked a history of medicine discussion list to recommend a book surveying plague studies to provide a good overview of the field. No one had any suggestions for this monumental task. Little did any of us know that about that time, Paul Slack’s Plague: A Very Short Introduction was being published (on March 24, 2012 according to Amazon) almost simultaneously with that conversation. When I first saw this book advertised I thought how could such a small book (pocket-size or easily purse size) at only 138 pages be worth much. Almost out of desperation, I ordered it. I am so glad that I did. Slack’s Plague proves that a book does not have to be long or packed with data to provide a good introduction to such a long-lasting and complicated topic.

Covering the entire history of plague and looking for the presence or absence of trends over 1500 years sets this book apart from most books on plague. Naturally, the Black Death and its aftershocks dominate but he makes an effort to continually use examples from the Plague of Justinian and less commonly the Third pandemic. Although he clearly approaches the plague as a historical topic, he gives adequate space to the discussion of the science of causes and nature of the pandemics. I think his best chapter is on plague’s role in the development of public health. This is a book that I will reread and study for quite a while to come.

Narrative grade: A.
Slack, an emeritus professor of social history, writes with the elegance and confidence of a senior scholar introducing but also assessing a field he has intimately known as a teacher and researcher for his entire career. While acknowledging areas of debate, he writes in very clear and even bold statements without the litter of caveats for every possible exception.

Historical Content grade: A

Slack covers all of the primary historical questions using plenty of examples without being tempted to follow them off track. One area that could have received more attention is medical care, which is only mentioned in passing along with the black death experience or the public health chapter.  He writes with clear thesis statements and well supported arguments. As a topic introduction, this is not a book that will provide data or even data summaries. Primary sources are translated and specialist terminology is avoided.

Scientific Content grade: A-

Scientific content is presented at the right reading level and with a rational discussion of the debates. This book was written before the full sequencing of a Yersinia pestis from East Smithfield in London. Slack is firmly on the side of Yersinia pestis and its continuous history.  He does not attempt to cover plague as a biological weapon or the modern status of plague.

References and Usability grade: B

The note system is rather strange and doesn’t follow any system that I am familiar with. It has an extensive ‘further reading’ section rather than a bibliography.

Illustrations: B

Figures, maps and graphs were okay for the size of the book.

The Dancing Plague of 1518

John Waller. The Dancing Plague: The Strange, True Story of an Extraordinary Illness. Sourcebooks, 2009 (paperback). Previously published as A Time to Dance, A Time to Die: The Extraordinary Story of the Dancing Plague of 1518 (Icon books, hardback, 2008).

Topic: Dancing Mania, choreomania

Time and Place: Strasbourg, Holy Roman Empire, 1518

Audience: General

Discussion:

This was a good book to wrap up 2011 with – from the Arab Spring, to summer revolutions and the fall’s occupy movement – conditions are approaching those of 1518. Among the peasants of Strasbourg, life in the early 16th century had become miserable. The church and monasteries left the peasants spiritually desolate and literally starving while their tithes of grain were sold at prices they couldn’t afford. Poor harvests and high inflation made famine a real possibility. There were several peasant revolts leading up to 1518 that were brutally put down with public executions and massacres. Ancient ties between the nobility, church and common people had broken down such that secular and ecclesiastic office holders no longer seemed to care for the welfare of the common people.

In July 1518 Frau Toffea was outdoors in the street of Strasbourg when she began to dance. There was no music or joy in her dancing. The spectacle soon became horrifying as it became apparent that she could not stop. Eventually she collapsed from the heat and exhaustion. When she woke up, she began to dance again in the same frenzy. Soon other people in Strasbourg began their trance-like dancing ignoring the heat and the need for food and water. When they were able to speak, they begged bystanders to make them stop. Before long in the July heat, people began dropping not to get up again – did they dance to an exhausted death or was there a pathological cause?

The people of Strasbourg didn’t see this as a psychological disorder but either physical or spiritual. At first they turned to the newly respected, university trained physicians who strangely proscribed more dancing as a cure. They assigned people to make sure the afflicted kept dancing even when they were capable of stopping. It became very apparent that this was not helping the death rate. Before long physicians and townspeople agreed that this was a spiritual ailment that required a pilgrimage to the local shrine of St Vitas. Fascinatingly the people believed that a saint patronized by epileptics could/would also curse people to uncontrolled movements like the dancing if they were displeased. Throughout this region of Germany and the Netherlands there are shrines to Vitas and other saints to prevent epilepsy and the dancing plague. Late medieval people greatly feared epilepsy and similar disorders because it could be perceived as demonic possession or a curse (by victim as well as bystander). Waller argues that this was something like a case of spiritual post traumatic stress disorder. His argument is too complicated for me to explain here but it is a worthwhile and thought provoking discussion.

Narrative: B+ The narrative was well written and kept me eager to continue reading. This is no small feat without a central cast of characters to follow through the book. He tries to use Frau Troffea as a continuing theme but just doesn’t have enough information to really flesh out her life.  There were places that I wished for more scientific context. I wish he had not saved so much of the science for the last chapter.

Historical Content: A- This is not a time period that I am very familiar so it is hard to assess how well he covered the historical questions. While he discussed actions of the church, he apparently didn’t have sources from within the church. This seems strange as the church usually has better resources than secular courts. The discussion of the religious context was good and mostly from the lay viewpoint.

Scientific Content: B-/C+ He seems to be reaching too far in some of the psychological parallels he tries to draw to the choreomania (dancing plague). Practices that intentionally create trances or mystical dancing are not good matches to the unintentional and unwanted dancing in 1518. The contagious nature of the dancing of 1518 is based at least partially upon the fear of the mania. Waller describes all mystical experiences in terms of pathology, which seems unwarranted. His brief discussion of an outbreak of uncontrollable laughing in Tanzania in 1963 left me wanting to know more (p. 216). A recent Ugandan outbreak of “nodding syndrome” where youths display uncontrollable nodding when they try to eat has been associated with a parasite that causes river blindness. In all three outbreaks, these may be related to epileptic-like behavior. My point here is that we can’t jump to the conclusion that initial cases are all psychological, even if some of the contagious nature does seem psychological (people being effected by watching etc).

I also have to take issue with a reviewers quote the publisher put on the back of the book. A quote from New Scientist stated “It’s a book to make you grateful for the historical increase in human sanity.” Part of the author’s argument is that manifestations of stress and PTSD are culturally dependent and that we express stress differently today. When we consider how many people today take medication for anxiety/stress, depression, PTSD or other psychological conditions it is questionable if there has been a “historical increase in human sanity” – not that manifestations of stress are necessarily measures of sanity anyway.

References and Usability: B The bibliography and notes are integrated together. This makes the bibliography much more difficult to use. The notes are consecutively numbered for the entire book and were a little sparse.  There are 238 notes for 231 pages of text. There were plenty of places I would have liked to have seen that he had a reference for a fact.

Illustrations:  B The maps and illustrations included were okay. It could have used a map of the local Strasbourg area that included the shrine of St Vitas.

Overall, I did enjoy the book and it is a very interesting episode in medical history. Community reaction to the outbreak is as interesting and influential as the disorder itself.  The power of the brain is almost always underestimated. Even if it wasn’t completely psychological, it manifested in ways that were surely under the control of the brain.

A tangent:  one of my favorite quotes from Waller’s book is not on the dancing mania at all. “Syphilis was the flagellum Dei, God’s whip, a stark warning about the sinfulness of adultery and fornication.” If it was the flagellum Dei before the invention of the microscope, imagine how they would have reacted to seeing a spirochete!

A Book Review Rubric

I hope to do more book reviews in the near future. I’m planning on posting these reviews naturally to share my ideas  but also as a record of my notes. One of the best pieces of advice I’ve received in the last year or so is that to become a better writer, especially long form writing, you have to read a lot of other people’s work; study what works and doesn’t work.

I’ve never been a big fan of rubrics but it could be useful here. Using a rubric will force me to consider all of these aspects of the book. I’m not particularly interested in coming up with a final grade. For some books, it may be OK to get a poor grade on one aspect. For example, the degree of referencing will depend on the target audience and the niche the book is looking to fill in the market as much as the author’s preference. Likewise, some books don’t attempt much of a narrative.

This is for non-fiction monographs only! I expect that it will be primarily for history of science/medicine and perhaps some science.

Book Review Format

Book Citation:

Topic:

Time and Place:

Audience:

Discussion:

Narrative grade

A = Hooked me from the beginning. Constructed a compelling narrative with good informative structure. Context and background does not break the flow. There is a logical flow from chapter to chapter.

B = Sections of good narrative and a logical flow between topics; context and background may not be well-integrated into the narrative.

C = Narrative doesn’t pull you through the book. Context or background chapters disrupt the narrative flow. Context and background information may be missing.

D = No attempt at narrative, reads like an interesting textbook or spliced together blog.

F = Reads like a boring textbook more concerned with packing in facts than story or argument.

Historical Content grade

A =  Addresses the primary historical questions on the topic or event without unnecessary tangents. Clear thesis statement or discussion supported by sections of the book.  Uses primary sources, artifacts, or data to support their topic/argument; primary sources are translated. Makes appropriate and relevant comparisons to modern life.

B = Addresses the primary historical questions with some unnecessary tangents. Thesis statement or discussion that is not as well supported as it could be. Uses primary sources, artifacts or data; primary sources are translated. Makes inappropriate comparisons to modern life.

C = Gaps in the topic coverage with little use of primary sources. Tangents  distract from the main topic or argument and tax the patience of the reader.  A few inaccurate facts or improbable interpretations. Makes inappropriate comparisons to modern life.

D = Thesis discussion is vague and unsupported by the text.  Large gaps in coverage and/or many inaccurate facts. Uses primarily secondary sources. Tangents seriously distract the reader from the main topic of the book indicating poor structure.

F = No thesis statement or main argument. Structure is poorly planned and executed. Uses only non-academic secondary sources with inaccurate interpretations of facts. Cherry picking sources to only support their argument.

Scientific Content grade

A = Correct, up-to-date scientific information with logical interpretations presented at the appropriate reading level for the audience.  If an argument is being made, science is correctly used to support the argument without bias.

B = Correct modern scientific information and conventional interpretations. Most of the information is presented at the right reading level.

C = A few incorrect scientific statements or improbable interpretations. Much of the information is not at the target reading level. Unnecessary scientific facts inserted into a historical narrative.

D = Some incorrect scientific statements and interpretations.  Incorrect scientific interpretations used to support a historical argument. Inconsistent reading level.

F = Incorrect scientific statements and interpretations used to support biased positions. Pseudoscience, uses some poor ‘science’ studies to support their position.

References and Usability grade

A = Full references with footnotes/endnotes and a complete bibliography. Appropriate historic or scientific sources. The footnotes/endnotes and bibliography are easily usable. Maps and figures are located within the text where they are most useful. Fully indexed.

B= Bibliography with only a few footnotes/endnotes on the most important facts. Footnotes/endnotes are available but not easily usable. Appropriate historic or scientific sources. Figures and maps are located all together (front or separate section) rather than within text. Could have used more maps or figures. Selectively indexed.

C = Selected bibliography or suggested reading list. No footnotes/endnotes and little or no index. Not enough maps or figures.

D = Slim or incomplete selected bibliography or suggested reading list. Little or no index.

F = No references or reading list, little or no index.

(Ironically I can see that books with poor referencing could have good maps and figures based on different audiences or targeted niches)

Illustrations

A = Plenty of maps and figures to aid the reader. Maps, figures and photos are well labeled with clear legends and referenced. Color illustrations if color aids understanding. Tables are professionally produced and easily read, complicated data is presented in tables.

B = Enough maps and figures for the reader follow the text. Maps, figures and photos are labeled and referenced. No color illustrations. Tables may be overly complicated and figures have difficult legends. Complicated data is not incorporated into table.

C = Not enough maps or figures for the reader to easily follow the argument of the book. Maps and figures are minimally labeled and with poor references. Tables not used to present data.

D = Lacks enough maps and figures to understand the text. Maps and figures have insufficient labels and legends to understand the illustration. No references on the illustrations.

F = Lacks (enough) maps and figures. Labels or legends are confusing or incorrect.

This rubric is obviously evolving. I could use some suggestions and criticisms. Do you seen any inconsistencies? Something that is missing? I’d love some feedback from authors and avid readers!

(Edited Dec 26, 2011)

Holly Tucker’s Blood Work

Holly Tucker, Blood Work: A Tale of Murder and Medicine in the ‘Scientific Revolution’. Norton, 2011.

I picked up this book at just the right time. I read it a few weeks ago just before I started teaching my summer anatomy course. Its always a good to be reminded of all of the work and drama that went into what seems like dull facts and standard procedures today. In this case there really was a lot of blood, sweat and tears by the medical establishments of two countries intensely throughout the 1660s before the work was banned for over a century. Holly Tucker’s Blood Work is centered on the century when the quest to understand blood went from counter-productive procedures based on medieval philosophy to the beginning of scientific understanding and experimentally based medicine.

Pride and glory drove the main protagonists of the story. For Jean-Baptiste Denis, the physician at the center of Blood Work,  the need to overcome his humble origins by proving his worth and more to the gentlemen physicians of France was a driving force. His benefactor Henri-Louis Habert de Montmor wanted to be the patron of the most brilliant, the most significant scientists of France, to be the Lorenzo de’ Medici to a scientific Michaelangelo. Add in an Anglo-French medical society rivalry and some pirates for good measure, and you have a page-turner of a history. I have to admit chuckling every few pages. Some of their experiments were like watching a train-wreck in slow motion. Holly Tucker is no doubt right that they were saved from causing much more damage by their inefficiency at transfusion.

I won’t give away any of the main plot or the murder, but there were some memorable sidelines. This description of ‘heroic medicine’ will stay with me for a while.

Claude arranged for a barber-surgeon to administer numerous bleedings to his brothers arms and legs. When bleeding seemed no longer to have any effect, they tried to place leeches behind Jean’s ears, but blistering there from other treatments with warming salves kept the leeches from doing their work. Bouillons, enemas, and purgings accompanied each bleeding in a desperate attempt to save Jean’s life. And to these were added chest rubs with concoctions of ground pearls mixed with extracts of hyacinth bulbs to warm Jean’s blood, as well as placement of gutted pigeons on his scalp to create heat to stave off the shivering. Despite Claude’s heroic attempts to save his brother (or perhaps because of them), Jean died a few weeks later. (p. 105-6)

Claude Perrault was one of the best trained physicians in France, and  a founding member of King Louis XIV’s Academy of Science. He held a prominent position in the Paris Faculty of Medicine and he used all learning to try to save his brother Jean. The idea of keeping your brother warm with a gutted pigeon on his head is priceless.

If you think that today’s publish or perish environment is tough, you should read what it did to Henry Oldenburg, who nearly single-handed published the Philosophical Transactions for the Royal Society of London. He volunteered his own time and talent, published at his own considerable expense for printing and postage, was accused to treason for gathering scientific news from France, and landed in the Tower of London for his troubles (where he had to pay rent for his prison cell). He then got out and worked even harder for the Royal Society (still for free) to reestablish his reputation. His treatment is enough to keep freelance science writers, bloggers, and researchers up nights.

I do have to say that I’m not bothered by the fact that the transfusion experiments were stopped. While Holly Tucker is no doubt right that other equally dangerous experiments and treatments were being done at the same time, the paradigm shift from blood letting to blood transfusion was too great, too fast. They didn’t understand even the basics of what they were transfusing and they were doing it for the wrong scientific and philosophical reasons. Simply stopping the blood letting would have improved survival significantly!

As memorable as the information and stories in Blood Work will be, perhaps more importantly it has made me think about the importance of narrative in books on history. So many of the history books I read are organized and written like textbooks, academic in their boredom as much as their content. I read them for their information rather than for entertainment. Its nice to have both!