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Contagion: epidemics, history and culture from smallpox to anthrax, edited by Alison Bashford and Claire Hooker

Reviewed by Sean Slavin

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'Contagion' Margaret Pelling writes, 'is spreading again.' This is due to various factors, she argues, including disease, politics, migrations and changed behaviours. Furthermore, new forms of communication have encouraged the metaphoric plundering of the term's more negative meanings of crowding and contamination. In this ambitious book, Contagion: epidemics, history and culture from smallpox to anthrax, editors Alison Bashford and Claire Hooker have set out to explore these multiple meanings and implications, including historical and cultural essays that address a diverse range of issues and events.

They sum their intent by writing: 'We are interested in the geographies, policies and identities which have been produced in the massive social effort to contain diseases – that extensive culture of hygiene which we know as public health but which we might also call "the dream of hygienic containment"'. Thus in a subtle way they signal a certain pre-eminence for the role of public health in shaping culture but also acknowledge that 'bio-medicine [is] culture'. This distinction is reflected in the division of the book into two sections. The first deals with 'Contagion and Cultural Histories of the Modern World' while the second addresses 'Contaminating Capacities in Post-modernity'. This distinction serves to establish not only a chronological ordering but also a disciplinary one, between history and cultural studies.

There are some very strong essays in this book. Margaret Pelling's 'The Meaning of Contagion' provides a subtle and sophisticated genealogy of the concepts of contagion and infection, as a related term, in western discourses of health and illness including medicine. Her selective history begins with the assertion that: 'Ideas of contagion are inseparable from notions of individual morality, social responsibility, and collective action'. She thus establishes the grounds for exploring the interrelationships between culture and medicine without speculating on the primacy of one's influence over the other. In doing so, she discusses the distinction that was gradually made between contagions passed between individuals versus those deriving from the environment. The latter view assumed untoward influence throughout the course of the nineteenth century despite extant specific medical knowledge that such diseases as smallpox were caused by known contagions passed on by contact. This resulted in the popular and public health belief that many diseases such as cholera and plague were caused by environmental putrefaction and passed through miasmas. These were seen as endemic problems of the metropolitan poor.

Warwick Anderson examines waste hygiene in the context of American colonial rule in the Philippines in the early twentieth century. Through an eloquent rendering of diverse primary historical sources he develops an argument that indigenous waste, in particular human excrement and, by implication, the entire local population who produced it and left it 'out of place', was a radical other to American colonial culture. Furthermore, the colonial power produced this othering in an ongoing fashion through the implementation and maintenance of various public health mechanisms and policies. His analysis spans wide categories, from the everyday observations of colonial wives to a brief history of the extraordinary technical machinery of colonial public health, including a significant laboratory capacity that at the beginning of the cholera epidemic in 1914 'was overwhelmed by more than 126,000 jars of faeces'. Anderson's wonderfully detailed historical and ethnographic descriptions serve a powerful argument. The business of 'civilising' the natives, in the particular form of sanitising shit, was an intrinsic aspect of the colonial project. This placed the Filipinos in a particular relation to their rulers and it also enabled science to further its own particular epistemological trajectory. Thus colonialism produces the colonisers as well as the colonised.

In another essay concerned with the relations between public health and colonialism, Alison Bashford and Maria Nugent argue convincingly that the confinement of lepers in Australia to such lazarets as Peel Island was indicative of broader racist concerns centred on miscegeny and the expansion of the frontier in the tropics. They provide strong examples that implicate public health officials in this policy, quoting from exemplary primary sources whose language of racism is shockingly recent. A disappointment I have with this essay is that, despite alerting the reader to a set of historical evidence written by the inmate lepers at Peel Island, they do not attempt to represent the living conditions there in any detail. They tantalise by revealing that inmates, who were mostly Aboriginal or Islander people, but not exclusively, frequently wrote to high level government authorities in Queensland making explicit appeals using civil and human rights discourses in order to contest their confinement. Not addressing this evidence and its implications more fully misses an opportunity to gain an insight similar to that offered by Anderson: that colonialism not only has effects but is also productive of subjectivities, discourses and epistemologies. This applies (in different ways) to both the colonisers and colonised. It seems a shame not to have given more voice to the Peel Islanders who not only lived the abjection of containment but also produced themselves as new kinds of social and political subjects as an effect of this otherwise horrendous condition.

One more essay in the historical section of the book is worth mentioning. Claire Hooker's fascinating account of an outbreak of typhoid in Moorabbin in outer Melbourne in 1943 deftly works with primary sources to build a powerful argument about the importance of government responsibility for population health. At the time, the Victorian State Department of Health effectively tackled the outbreak through a range of strategies that involved action at a community level, rather than the isolation and stigmatisation of the source of infection (which was quickly identified as a local dairy worker). Amongst a raft of community-based public sanitary measures that were speedily implemented, perhaps the most significant was the introduction, via legislation, of universal pasteurisation of Victorian milk. Hooker uses this signal example as a way of arguing against the contemporary tendency to view public health as a set of issues primarily related to individuals who must take 'responsibility' for 'lifestyle choices'.

The most successful of the more discursive essays in the second section of the book is Marsha Rosengarten's 'Porcine Viruses and Species Boundaries'. This essay moves effectively across a number of registers, including discussion of interspecies relationships in the film Babe, well rendered and interesting discussions of xeno-transplantation (cross species organ transplantation) and the possibility of porcine viruses infecting humans. Rosengarten is admirably honest at the start of her essay in admitting she is uncertain about what constitutes contagion. Her unpacking of debates around xeno-transplantation allows her to ask a set of questions around what constitutes a human and more generally where the boundaries between species lie. The answers are not clear and thus the notion of contagion becomes blurred. This implies a number of possibilities about which Rosengarten seems rightly unsure. Some of these could be seen as potentially positive, allowing humans to break out of what is merely human and integrate with the best of other species, or it could more darkly imply the wholesale plundering of what is extra-human. It strikes me, however, that although much of this technology is new the issues are not. Rosengarten alludes to this by briefly mentioning human/porcine relationships in Papua New Guinea. The example is not a good one as it overly simplifies a complex and often fraught issue on which much anthropological literature exists. Rosengarten implies but does not ask a simpler question: why should we be disturbed by the transplantation of pig organs into humans when we readily eat bacon for breakfast? More broadly, Rosengarten is correct in arguing that the possibility of viral contagion is tantamount to a biomedical ruse for concerns that really coalesce at the borders of the 'properly human'.

'Contagion' is an ambitious book, both in terms of the subject matter but also its methodological and analytic eclecticism. The most successful essays are those that stay close to primary sources of evidence, either historical or ethnographic, and build arguments firmly grounded in cultural and historical context. The least successful are those that make arguments based on secondary sources and knowledge divorced from the contexts that produced it. This has at times been a criticism of cultural studies approaches more generally but is particularly evident here when set against such good scholarship as that of Pelling, Anderson and Hooker. Rosengarten's essay overcomes this problem to some extent by moving closer to philosophical reflection rather than cultural analysis. Pelling, Anderson and Hooker confine themselves to addressing the meaning of contagion in relation to bio-medicine and public health and are significant contributions on that account. They are not, however, limited to engaging with these discourses and, in terms of achieving the editors' aims of examining the broader metaphoric or cultural meanings of contagion, their success derives from their close and precise attention to cultural context and historical evidence.

Sean Slavin is an anthropologist working at the Australian Research Centre in Sex, Health and Society, La Trobe University. His current research focuses on the social contexts and cultural meanings of injecting drug use.

Contagion: epidemics, history and culture from smallpox to anthrax, edited by Alison Bashford and Claire Hooker, was published by Pluto Press in 2002.

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