A Modern Contagion: Imperialism and Public Health in Iran's Age of Cholera by Amir A. Afkhami

Abstract

Reviewed by: A Modern Contagion: Imperialism and Public Health in Iran's Age of Cholera by Amir A. Afkhami Kusha Davar, MD, MBA, MS (bio) A Modern Contagion: Imperialism and Public Health in Iran's Age of Cholera by Amir A. Afkhami, Baltimore, MD: Johns Hopkins University Press, 2019. ISBN 978-1421427218 A Modern Contagion by Amir A. Afkhami is not only an excellent, but timely, description of the epidemics that have plagued Iran for much of the 19th and 20th century. the book, Afkhami dives into details surrounding the multiple bouts of cholera and other pandemic outbreaks experienced by Iran and the incremental increases in public health responses that came as a result. The book captivates any member of the general audience, while additionally engaging members of the health care field based on its ability to highlight the consequences in the gaps of care for the underserved, especially in light of the COVID-19 pandemic we are currently experiencing. A Modern Contagion walks the reader through the coronation of Iran's cholera epidemics in the 19th century. At that time, Iran's public health consisted of religious and galenic ideals that served to describe infectious diseases and guided treatment responses. However, as the century progressed, Iran's public health leaders began coming in contact with the West and receiving formal European education in medicine, which increased Iran's capacity to address pandemic cholera outbreaks. This ultimately led to the country having a formal public health system that was autonomous and clear from control by Russia and British-India. At the time, Iran represented an underserved region and thus formal education had proven beneficial to allow for the country to prosper and advance. Afkhami beautifully illustrates that each time Iran was stuck with illness, the country seemed to have strengthened public health measures, displaying the benefits of a reactive society. The book describes the formation of several International Sanitary Conferences that led to the eventual creation of a distinguished Iranian Sanitary Council as a formal advisory board to the Iranian government. Lastly, A Modern Contagion parallels Iran's advancements and challenges in public health growth to historical events such as the advent of print, helping with the spread of information, and increased international travel leading to the dissemination of infection, respectively. Afkhami describes how the underserved often lacked autonomy and decision-making power due to a lack of resources and capital. As time progressed in the 19th century, the weakness of the executive authority of Iran became more apparent leading to further epidemics, a fractured economy, and the country's first foreign loans, setting a pattern of borrowing and dependence in a global economy. Afkhami also notes additional obstacles, including outbreaks of the Bubonic Plague in the 19th century leading to quarantines, and the closing of Iran's borders and its relinquishing of jurisdictional power over its public health to Russia and Britain. Ultimately, the saving grace of Iran's control of cholera was the adoption of revolutionary ideas, such as the germ theory of disease, which radically altered the perception of illness among the country's [End Page 1505] healthcare leaders and eventually the general public. This led to a downstream series of events including The Constitutional Revolution at the beginning of the 20th century, which made Iran's government more democratic; again, this was a direct result of the public's increased understanding of diseases and the government's responsibility to provide sanitation and prevent disease. With a more representative government and success in disease prevention came increased funding to implement Iran's first national vaccination campaign, specifically against smallpox. At that point, Iran was creeping out of the shadows as an underserved region from a medical and public health standpoint. As the 20th century advanced, Iran opened the Pasteur Institute which helped to promote microbiology and infectious diseases in the country's system of medical education. Lastly, as the Iranian Ministry of Public Health was established, Iran began working with the World Health Organization, helping its public health system rise to international standards and largely eradicate the scourge of cholera from the country. Afkhami closes the book by discussing the...