Myron Echenberg, Plague ports: the global urban impact of bubonic plague, 1894–1901, New York University Press, 2007, pp. xvi, 347, $48.00 (hardback 978-0-8147-2232-9).

Abstract

Chinese astrology marked 1900 as the year of the rat. The irony of this was not apparent until six years later, when the rat's role in the transmission of bubonic plague finally gained public and scientific acceptance. The third bubonic plague pandemic raged from 1894 into the first quarter of the twentieth century, taking more than 15 million lives. Echenberg has followed its chronological path from its Asian beginnings in Hong Kong and Bombay, to Europe (Alexandria and Porto), South America (Buenos Aires and Rio de Janeiro), America (Honolulu and San Francisco) and finally to what he classifies as the British imperial examples (Sydney and Cape Town). The accumulation of air miles is the smaller part of the reward for his scholarly travels. For each of the ten cities, Echenberg has addressed key questions: how did the disease arrive? How many did it infect and kill? What were the popular and institutional responses? What impact did the changing understanding of plague transmission have on the control strategies? Some of these questions have not been asked of the third plague pandemic before, and certainly not in such a systematic fashion. Echenberg recognizes the enormity of his task, and potential limitations. He seeks to analyse the tension between western cultural imperialism and older indigenous medical responses to disease, but language barriers force him to rely heavily on western interpretations of Confucian, Buddhist, Ayurvedic and Islamic approaches. His second key aim, to analyse the interplay between older sanitarian and newer bacteriological disease strategies, is more attainable, and aided by the book's chronological structure. He is able to follow the contested knowledge on the roles of the rat and the flea, and to analyse why some of his case study cities resisted the new bacteriological construction of disease. Considering the speed with which Echenberg moves between these cities, he successfully contextualizes each plague outbreak in 25 to 30 pages. He allows the human factor in the plague responses to shine through the scant statistical information. The cumulative effect of the ten city studies is to impress on the reader some universal themes: fear and victim-blaming; the political economy of infectious disease; that class has more clout than race when fudging sanitary reform strategies; the vastness of the cultural gaps within some cities, and the smallness of the scientific world. Where this book is slightly lacking is in the connections between these fascinating accounts. There are short summaries on each pair of cities, but little sustained comparative analysis. For example, why do the British authorities not learn from the Hong Kong outbreak—a “study in cultural misunderstanding and rumour-mongering”—and apply such lessons in Bombay? Why do the Americans consider a plan to raze San Francisco's Chinatown, when they have already seen the devastating and unproductive results of a similar exercise in Honolulu? The imperial theme, adopted briefly at the beginning and used to order the pairings, is not followed through. Yet the Whitehall gaze must have impacted on how some of these cities reacted to the plague. The fact that Echenberg has travelled in the footsteps of Bruce Low, a British government medical officer sent out in the immediate aftermath of the plague pandemic to report on how it was handled, appears lost on him. The other area that would have benefited from a clearer focus is the “port” aspect of these cities. Echenberg exploits this unifying feature to gain a catchy title for his book, but the explicit maritime aspect subsequently remains undeveloped, apart from a few passing references, for example, to Sydney's role in improving rat-guarding measures on ships, or the tension in Alexandria between the urban and port authorities. Yet one has to admire the sheer range of information packed into this volume, and its accomplished narrative style. In 1996 the World Health Organisation re-classified plague as a “re-emerging” disease. This is an important book that, through its ten city repetition of the threat and reality of epidemic disease, provides inspiration for historians and health authorities alike.