by Gerald N. Grob
Harvard University Press, 2003
Review by Mark Welch, Ph.D. on May 6th 2005
Gerald Grob has
taken on an enormous challenge and accomplished it superbly. In The Deadly
Truth he seeks to chart the history of human and social interactions with
disease, death and their responses from pre-Columbian times to the present day.
He does this with a command of a huge literature of demographic statistics,
medical reports and locates them within a social and cultural context that
shows both relative and historical value.
In a very careful
and precise manner Grob begins to describe, according to the best verifiable
sources he can find, what he calls the "reality of the disease, rather
than the manner in which different generations interpreted them". He seeks
to explain the relationships within his data, and to give balance, even to let
the facts speak for themselves. But he is not a disinterested observer, and he
is capable of moving descriptions of the conditions of the poor and benighted.
He knows very well, and conveys his understanding of the terrible experience of
child mortality, maternal death, shocking survival rates and a life riddled
with chronic infection and disease.
of the pre-Columbian period is well-researched with great use of original
sources. He makes an interesting comparison with the state of health in the
Europe of the time, and the health of the First Nation peoples, and shows that
in some surprising ways Europe was not all that advanced.
He describes how
with the increasing urbanization of America, the overall health status of the population in fact began to
decline. Generally, throughout the early Nineteenth Century the standard of
healthy living was much worse on the cities than in rural areas. Proper access
to clean drinking water, cramped living conditions and often a greater exposure
to novel diseases and viruses, all made city living a more hazardous option
than life on the farm. However, with a series of public health measures many of
the common diseases became less prevalent and more controlled, but as Grob
emphasizes a number of times, medicine is more like the boy holding back the
dyke than the conqueror or pestilence.
He is particularly
interested in the effects of industrialization and iatrogenic disease. He
describes the use of heavy metals and the effects of environmental pollution,
he speaks of industrial health and safety (well what little of it there was)
and it is no great leap of either the imagination or of logic to argue that
this is currently a problem of immense importance in the developed world whence
so many of these industries and their work practices have been exported.
But, just as the
infectious diseases seem to be coming under control, Grob surprises us with the
"discovery of chronic illness". This has therefore had a major, and
unforeseen, effect on the nature of medical services. The bullish optimism that
might have predicted the eradication of disease and a health for all, seems
sadly misguided. In the developed world many of the usual statistical markers
of health, life-span, disease prevalence and incidence and so on, may be
positive, but the quality of life, chronicity and the end of life issues are
all queering this particular pitch. It may be that the crusading nature of
medical ventures will give way to something far more modest.
The book is
magisterial in style. It makes its points carefully and slowly. But it is not
ponderous. It uses the evidence to bring the reader to a conclusion, rather
than providing the conclusion first. Indeed, there are over 60 pages of notes
and references. It is academic and scholarly, and a major contribution to the
However, it is not
a paeon to the triumphs of medicine. In fact Grob seems to be rather
pessimistic about the long term ability of medicine to do very much more that
stem the tide of disease and relieve the suffering of the sick. He seems to be
careful of any hubris or triumphalism; diseases seem to have a way of coming
back and biting you on the ankle. There is, as his final chapter has it, no
Welch, Ph.D., Assistant Professor in the Faculty of Nursing at the University of
Alberta, Edmonton, Alberta and Co-Director of the PAHO/WHO Collaborating Centre
for Nursing & Mental Health.