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How Not To Write About Deadly, Infectious Diseases Like Ebola

Zoom Doffo/AFP/Getty Images

In 1999, 23 years after the world first encountered the Ebola virus, C.J. Peters and J.W. Leduc put together a special supplement for The Journal of Infectious Diseases entitled Ebola: The Virus and the Disease. It began: The family to which Ebola belongs “is the only known virus family about which we have such profound ignorance.”

Today, 15 years after the publication of that supplement, as we face the most destructive Ebola outbreak thus far, we find that our ignorance remains profound. We still do not know the virus’s natural reservoir (the fruit bat is currently suspect number one). We still do not know if the virus is endemic to the area around northern Zaire. (During that first outbreak in 1976, doctors found antibodies already in the blood of some people in that region, but this most recent outbreak originated in Guinea, 2,000 miles west of Zaire.) We still do not know how a virus so simple in structure manages to affect animals and humans so devastatingly. “The Ebola virus has only seven genes,” according to an article published in the journal Nature, “compared to the thousands in a bacterium.” And we still do not really know why some people survive infection and others do not. In the face of all this collective and “profound ignorance,” how are we to begin making headway?

Confronting Contagion by Melvin Santer

Melvin Santer’s new book, Confronting Contagion: Our Evolving Understanding of Disease, offers us a historical account of how philosophers and scientists have approached this daunting question over the past 3,000 years. Santer is professor emeritus of biology at Haverford College, and he’s been studying diseases and their causes for more than 50 years. That the publication of Confronting Contagion comes at a time when we are confronting a deadly contagion, is purely fortuitous happenstance. There must be publishers rushing to the topic, but this is not one of those books. Unfortunately, it is also not the type of book one wants to read at a moment like this. 

Santer begins with Francis Bacon’s seventeenth-century model of the scientific method: observation and hypothesis formation followed by the collection of data. But at the introduction’s end, Santer reminds us, by way of a quote from Carl Hempel, a twentieth-century philosopher of science, that “The transition from data to theory requires creative imagination. Scientific hypotheses and theories are not derived from observed facts, but invented in order to account for them.” In other words, a large part of science is a form of narrative.

From here, the book begins its encyclopedic exploration of the various narratives that men (and in Santer’s book, it is exclusively men) have told themselves about contagious disease. After starting with Homer, Hesiod, and the Jews, all of whom viewed disease as gods- or God-caused, Santer briefly mentions Herodotus, who observed the transmission of disease by rodent, and then Thucydides, who was the first person to document, even if somewhat unwittingly, the activity of a contagion being passed between people, when he noted that people tending to the sick died more often than those who kept their distance. In the most clumsily written chapter of the book, which elucidates the origin of “natural causes,” Santer crams 19 philosophers (all the major pre-Socratics as well as the usual suspects: Socrates, Plato, Aristotle, Lucretius, etc.) into fewer than 14 pages. Once the early history has been covered, the book stumbles its way through a thousand years in five pages, before toppling into England during the Black Death of 1348. From there, until the end, Santer’s work devolves into a byzantine series of historical episodes covering a six-hundred-years long argument between an ever-changing cast of well-respected and intellectually stubborn, white men.

Santer is fully cognizant of the fact that his mode is, to say the least, circuitous. “This book does not provide a linear narrative history of our understanding of the cause of infectious/contagious disease,” he writes in the prologue. “Instead the storyline focuses on historical episodes, and most importantly the foundations of belief, to understand the origins of the arguments that justify the various causes.” When a writer says they have chosen one approach to writing their book over another, it in no way indicates that they have chosen correctly.

Unfortunately, organization is not the book’s only flaw. There is the repetitive nature of Santer’s explanations; each time he brings up Lucretius, he reminds us that “the poem De rerum natura … was infused with … a materialist philosophy that envisioned the world as constructed of an infinite number of atoms” and then reminds us a few sentences later that “Lucretius used a theory of atoms to explain the origin and development of living beings.” In case, 20 pages later, we have managed to forget this, he tells us again. There is also Santer’s desire to quote instead of paraphrase; whenever it looked like a series of quotes was about to spill over to its third page, I began wondering if it wouldn’t serve me better to read the primary sources.

But the most egregious of the book’s flaws is the limited scope of Santer’s “our” in his subtitle Our Evolving Understanding of Disease; the text deals almost exclusively with Western men of the academy, giving Muslims a few pages to illuminate the story of how they were responsible for preserving texts that would allow ancient Western thought to reenter Western medicine a thousand years after it had, for the most part, disappeared. Even if the book had not had these issues, it would still be a disappointment. And I was disappointed. We need a book like this, a text that tells the story of how we, as a people, have confronted contagion since the beginning of written history. 

When Santer decided to eschew narrative in favor of episodes not always chronologically ordered, while simultaneously attempting to describe the evolution of an idea, he put himself in an impossible situation. By nature, the evolution of almost anything is a story. We will eventually learn the story of Ebola, as we did with that of the Black Death. (It was only four years ago that the etiology of that particular plague was officially settled.) The one thing Santer’s book offers the reader is an opportunity to witness how confident certain men were in the stories they told themselves about disease and how often times this confidence led to the significant stunting of scientific progress.

The best part of Santer’s book relates a story from the early 1700s. While the men in their academies argued over whether or not diseases were produced by spontaneous generation, an “old woman” was traveling around England “with a nut-shell full of the matter of the best sort of small-pox,” which she would inject into little children, inoculating them against a disease that would go on to claim 400,000 European lives each year of that same century. It’s odd, though, that this anecdote, the only one in Santer’s book to include details of common people confronting contagion, would serve as lede to a chapter concerning the end of the 19th Century.

Confronting Contagion intends to focus on “the foundations of belief” regarding contagion and not those of actions. But surely, the woman inoculating those young children worked from some story she told herself. I want to know what that story was. More importantly, I’d like to know why it didn’t make it into this book. Santer only relates this story so that he has something to say before going on to discuss Louis Pasteur, who would eventually get into the inoculation business, a hundred a fifty years after this “old woman.” When we sidestep the stories that appear to be sitting at the margins of history, we sometimes learn, a little too late, that marginality was only an appearance.