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book reviews Bull. Hist. Med., 2001,75 143
of the American continent. From the first page Guerra indicates
that demo-
graphic abysses cannot be explained by murder or battle, for the
number of the
fallen was very small in proportion to the population, and high
mortality oc-
curred mostly while Spaniards and natives coexisted peacefully
in colonial times.He points to similar demographic catastrophes in
English and French America,and compares these to the population of
the Philippines, with its evolutionary
and epidemic history related to Asia, which did not show a
decline during the
Spanish colonial period. Epidemiologa is a monumental
achievement, bursting
with rare and unexpected information, such as differential
mortality rates by
race; the geographic transmission routes of diseases; early uses
of prevention
methods (quarantine, inoculation, cohorting); sixteenth-century
Mexicos hos-pital republics (towns of native Americans established
with a hospital as their
center); diseases introduced into Haiti by African-American
immigrants from the
United States (182426); and the Latin American humor in giving
names toepidemics.
The book opens with a disclosure of the authors personal
research on the
diseases to be discussed, particularly typhus and influenza (his
career has in-cluded the roles of military physician, research
pharmacologist, and historian).
The most important sources of demographic and medical
information for the
period 14921898 in the Americas and the Philippines are then
discussed. Four
succeeding chapters (Iberian man, American man, Iberian
diseases, American
diseases) show the hallmarks of Guerras writing: panoramic range
and terse
exposition. To describe the evolution of the human groups that
met in colonialtimes, special emphasis is placed on migrations,
environments, domestic animals,
and microbial pathogens. Guerra stresses that the most important
epidemio-
logic fact in pre-Columbian nosology is the absence of viral
diseases (p. 88) and
therefore the lack of immunity to them. Epidemic chronology
presents a 432-
page annotated list of 1,631 epidemics in humans and animals in
a 406-yearperiod, from Alaska to Patagonia and from Barbados to the
Philippines, often
providing the number of the dead and the size of populations, to
document the
astonishing mortality rates of infections. Three short chapters
summarize the
impact of these events and the societal response (religious
interpretation, foun-
dation of hospitals, treatment and prevention methods), and
correlate epidem-
ics and population estimates to show the devastating effect of
the first century ofcontact between natives and Europeans. This
contact occurred in the sixteenth
century from Mexico to Chile and in the seventeenth century or
later in present-
day Canada and the United States. The microbial pathogens that
most affected
demography in the Americas from 1492 to 1898 are judged to be
smallpox,
typhus, measles, influenza, yellow fever, and dysentery.
The remaining 210 pages provide summary listings of the
epidemics bydisease, and annual population censuses for cities from
Boston to Manila, includ-
ing, where available, natality and mortality, with especially
abundant data forMexico City and Havana. A 63-page bibliography in
nine languages shows the
books deep foundations, citing authors from Christopher Columbus
to Marcos
Cueto and Howard Markel, and sources from pre-Cortesian codices
to the
National Geographic.
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144 book reviews Bull. Hist. Med., 2001,75
The immenseness of this database produces accessibility
problems. Guerras
punctiliousness in citing all possible epidemic diagnoses, while
respectful of
alternative hypotheses, requires the reader to contrast
different entries for the
same disease or epidemic, a task made difficult by the absence
of a subject index.For that reason, the book is begging for an
edition in CD-ROM format.Epidemiologais timely, given the current
interest in the epidemics that could result from acts of
bioterrorism on nonimmune populations. It is an important new
resource, and
its English translation would be welcome by non-Spanish-speaking
medical and
social historians, and infectious disease researchers.
Jos G. Rigau-PrezUniversidad de Puerto Rico, Ro Piedras
