`Black October': the impact of the Spanish Influenza epidemic of 1918 on South Africa

In particular, the modern histories of specific diseases offer ideal ground for a union of diverging sub-disciplines, and Victoria Harden's immensely readable and scholarly monograph on Rocky Mountain spotted fever elegantly demonstrates that a successful integration is possible. Beginning with the disease itself-a virulent, seasonal, and unpredictable affliction of the Bitterroot Valley in Montana-she traces the modern evolution of the biomedical sciences in America, without ever losing sight of the popular beliefs and fears, and the local economic pressures, which gave meaning to the efforts of the scientists involved in spotted fever research. Her task is perhaps made easier because spotted fever was first identified as a specific infection in the last years of the nineteenth century, and initially seemed to occur in virulent form only in the Bitterroot. Harden's lucid prose and breadth of perspective contribute much to the quality of this book, but the precise geographical location of her core subject and its defined historical span facilitate a cogent account. Her example might prove harder to follow in the case of other diseases. Rocky Mountain spotted fever is one of a large group of spotted fevers of varying degrees of severity which occur throughout the world. Generally tick-borne, and caused by the microorganisms known as rickettsiae (which also cause typhus), these fevers are diseases of nature: their cycles of transmission involve man only accidentally. The Rocky Mountain variety was responsible for fewer than two dozen cases a year, but its dramatic symptoms and high fatality rates (up to 70 per cent of cases) made it a serious problem in an area anxious to expand its apple-growing industry and nascent tourism. It was demand from within the Bitterroot that kept research going, with often precarious funding, in the early decades of this century. The steps by which some control over the disease was achieved followed closely on developments in other areas of medical research. The discovery of arthropod vectors in the field of tropical medicine led the earliest scientific investigators of the Bitterroot's problem to the tick vector; work on typhus vaccines in the mid-1920s inspired the development of the first spotted fever vaccine (by a laborious and dangerous process of crushing infected ticks in salt solution); research on filterable viruses in the 1930s made possible new methods of preparing vaccine; the antibiotic revolution of the 1940s produced drugs effective against several rickettsial diseases. Spotted fever research did not …