Fascinating but flawed book explores how sickness shapes our lives

The Great Shadow
Susan Wise Bauer, St. Martin’s Press

It may be perverse to say it, but this is a fine time to publish a book about the history of sickness. We are currently spluttering through a particularly virulent winter in the northern hemisphere. And, of course, we all remember the even worse winter of 2020-21, when we locked our doors against the covid-19 pandemic. The fragility of our bodies is, as they say, front of mind.

So here is The Great Shadow: A history of how sickness shapes what we do, think, believe, and buy by Susan Wise Bauer, a millennia-spanning account of the effect of illness on individual lives and on collective beliefs and actions. Everything from the idea of guilt to the contents of your shopping trolley has been touched by the organisms that make us feel poorly.

The problem is that other people had the same good idea. Since the pandemic, we have had, among others, Jonathan Kennedy’s brilliant Pathogenesis, and updated versions of Sean Martin’s A Short History of Disease and Frederick F. Cartwright and Michael Biddiss’s Disease and History. So what’s new here?

The answer is emphasis. Bauer concentrates on the shift from what she calls the “Hippocratic universe” to our age of “germ theory”. The former is defined by near-superstitious adherence to ideas first floated in ancient Greece – of humours, bodily fluids and internal harmony. The latter is more rooted in actual science.

One thing the book does make startlingly, saddeningly clear is how long the changeover took. The medical consensus that microbes cause our sicknesses – which, in turn, helped bring about advances in vaccinations and cures – took centuries to emerge, only taking hold in late Victorian times. The cost can be counted in millions and millions of premature deaths.

But have we left Hippocratic medicine entirely behind? As well as a historical narrative, The Great Shadow is also a kind of argument. Each chapter adds to the chronology – passing through urbanisation, the Black Death, the trenches of the first world war – before relating everything to now. All too often, says Bauer, there are holdovers from the past in our modern attitudes towards sickness.

At best, this is an unenlightening form of inquiry: does it surprise you that 19th-century anti-vaccine campaigners were a bit like Trumpian anti-vaxxers? At worst, it is simply baffling. Take the passage, riskily early in the book, in which Bauer admits she didn’t go for check-ups for some years after the covid-19 pandemic because she “didn’t want to be lectured” for gaining 8 kilograms. Apparently, that lecture would have been her doctor “operating out of [a] Hippocratic understanding of what illness is” – rather than, say, an informed judgement about the consequences of weight on health.

Still, if you persevere, there is light in The Great Shadow. Despite a tendency to overwrite (“That sky is the residence of mystery, a mirror of the unknowable”), Bauer knows how to weave stories from archival sources. Her chapter on the pioneers of germ theory, like Alexander Gordon and Ignaz Semmelweis, being shunned by the medical establishment and, indeed, driven to illness for their efforts, deserves to become a Netflix miniseries.

Then there is the book’s final, most memorable point. We have mostly moved from superstition to science, but something else has followed. Our age, dubbed the Third Epidemiologic Transition by academics, is, says Bauer, “marked not only by the failure of [antibiotics] and the emergence of brand-new diseases with no vaccines or cures, but by a global transportation system that makes it… likely… those diseases will spread rapidly around the world”.

Peter Hoskin is books and culture editor at Prospect magazine