versión On-line ISSN 2078-5135
versión impresa ISSN 0256-9574
SAMJ, S. Afr. med. j. vol.102 no.10 Cape Town oct. 2012
The carefully chosen account of the five epidemics that emerged in South Africa over a few centuries following European conquests makes for fascinating reading. The book is rich with detail, eminently readable and entertaining, the seriousness of the subject matter notwithstanding. It is well written, concise and covers complex, often unappreciated, historical events.
The comparative impotence of biomedicine in the face of these epidemics stands out as a major feature of this history. What stands out even more, however, is the 'politics' of epidemics. In South Africa, not surprisingly, the 'victim blaming' to ok on 'racial', religious, geographical and xenophobic tones with slave, Khoi, Muslim, migrant, the German Kaiser, the British, blacks, whites, Christians, and others, cast as villains responsible for the outbreaks. Such 'micropolitics' led to 'macro-politics' which shaped and disfigured the South African spatial and political landscape. The establishment of Ndabeni, Langa, Klipspruit, later Pimville, and Soweto, among others, were some 'macro-political' consequences of epidemics. The book describes many examples of such macropolitical machinations and provides tangible evidence of the role of the 'people of politics' in society's response to the five epidemics. But not all political consequences were bad. South Africa has the epidemics to thank for the establishment of a ministry of health, the emergence of health-orientated NGOs, and the production of vaccines.
The rich epidemiological detail included in the accounts provides a numeric measure of the sheer scale of the epidemics. The mortality rates in most of the epidemics, except for polio, were horrendous! The numbers allow for comparison and it is a revelation to see how comparatively 'less severe/benign' HIV/ AIDS mortality is when compared with some of the other more acute epidemics. Of course, the numbers do not reflect the full picture and the author describes the trans-generational aftereffects of the epidemics with great insight.
The dialectical relationship between epidemics and conquest, conflict and war, is illustrated in the accounts of almost all the epidemic diseases. The chapter on HIV/AIDS provides extraordinary insights into the complexity of the epidemic, and it gives one a great appreciation of the added perspective that a historian brings to our epidemiological understanding.
I recommend the book to all scholars in the health sciences, of history and the social sciences. It provides an extraordinary review of epidemic disease through the prism of history and enriches our understanding of epidemics, while at the same time enhancing our understanding of human society.