Contagious: cultures, carriers and the outbreak narrative. Priscilla Wald. Durham: Duke University Press, 2008 (xi + 373 pp). ISBN 978 0 8223 4153 6.

Although the medical aspects of communicable diseases are no doubt fascinating, the impact of infections on our local and global community is no less enthralling. Richard Preston’s The hot zone and Ken Alibek’s autobiography, Biohazard, are two examples of such intriguing narratives, the former a spine-tingling tale of the discovery of Marburg and Ebola infections and the latter exploring the Soviet bioweapons program and Alibek’s defection to the United States. Priscilla Wald’s book, Contagious, is not just another narrative about various outbreaks. It is primarily about the historical and social views in times past and present and how they paralleled, influenced and were themselves influenced by the emergence of infectious diseases.

Contagion literally means to “touch together”, and originally referred to the circulation of seditious or dangerous ideas. It eventually came to be adopted as a term for communicability of infections, retaining the negative connotations of its origins. Highlights included the stigmatisation of “superspreaders”, those people who deliberately or unwittingly infect large numbers of people. Wald gives examples: a flight attendant during the SARS outbreak in 2003; Patient Zero during the early AIDS epidemic; and probably the most famous superspreader of them all — Mary Mallon, also known as Typhoid Mary, who was a healthy carrier of typhoid fever in New York in the early 1900s.

Wald describes how at least one contemporary author cast Typhoid Mary as a “fallen woman” sexually. It was as if her supposed sexual transgressions, her mobility and independence — so different from that of the stereotypical virtuous woman of the time — allowed her to take on the role of a superspreader. Similarly, the ghettos in Manhattan of the early 20th century were not just seen as a home to new arrivals to the United States. They were simultaneously regarded as concentrated areas of foul infections and unfamiliar cultural beliefs emanating from immigrants waiting to be “Americanised”. Wald describes this as “medical nativism”, where one justifies the stigmatisation of immigrants through their association with communicable diseases.

Wald also draws an interesting parallel between communicable diseases, the communist threat of the Cold War and popular fiction of that time (such as The body snatchers), where normal people have been infiltrated or “infected” by malicious influences, transforming them into “human-looking monsters”.

The author herself is not a medical doctor but a Professor of English at Duke University in the US. The book is extremely well written, although it isn’t a light read by any means. It is a good book that has given me a new perspective on the outbreak narrative.