American Scientist

THE GREAT SHADOW: A History of How Sickness Shapes What We Do, Think, Believe, and Buy. Susan Wise Bauer. 352 pp. St. Martin’s Press, 2026. $30.

Think about the last time you got sick. You might have been a little miserable, but with hot drinks, plenty of tissues, and maybe some secret family remedies, you lived to tell the tale. And you told said tale, complete with an explanation of how you got sick, what you did to treat it, and what you might do differently to avoid it in the future. Your story makes sense because illness is one of the few universal human experiences across time and space.

In The Great Shadow: A History of How Sickness Shapes What We Do, Think, Believe, and Buy, Susan Wise Bauer writes that throughout history, explaining and preventing illness has played an outsize role in how we relate to each other and to authority. Explanations for infection are at the root of a vast array of historical phenomena, from ancient religious rites to an obsession with “equilibrium and symmetry” in our bodies and in the environment, and even to our 21st-century “antiseptic culture; a Tupperware-enclosed, plastic-wrapped, disposable world . . . [with] separate drinking fountains and lavatories for those who carried ‘different’ sorts of germs.” As Bauer writes, “Our contradictory, overlapping ideas about sickness create layers of tension, edges of conflict, fatal inconsistencies.”

Bauer takes a broad historical view of sickness and health in the Western world, tracing how we have sought to make sense of the fragility of our bodies and the impact those explanations have had on individual and collective human behavior. Focusing primarily on what we now call infectious diseases, Bauer deftly mines archaeological, philosophical, epidemiological, religious, and historical sources to analyze Western attempts to make sense of sickness and death since prehistoric times. Our desire to understand and control the causes of illness has also been a desire to blame and judge others, and Bauer solemnly illustrates how the emergence and persistence of antisemitism and other deadly forms of racial discrimination can be traced in large part to explanations for epidemic diseases.

We echo Hippocratic beliefs about balance when we worry about catching a cold if we go outside with wet hair despite knowing about viruses, and we recall miasma theory when we spray air fresheners so that our rooms will smell minty fresh.

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Bauer cautions readers to remember that the history of illness is not a story of linear progress, and that “the old outdated understandings of illness don’t simply disappear. They linger on. This dissonance often shows up in harmless and passing ways. . . . But it also causes sharp rifts,” such as when “anti-vaxxers turn their backs on germ theory and rely on proper life balance (yogurt, herbs, cold-water baths) to keep their children safe.” Some of us echo Hippocratic beliefs about balance when we worry about catching a cold if we go outside with wet hair despite knowing about viruses, and we recall miasma theory when we spray air fresheners so that our rooms will smell minty fresh. Bauer acknowledges that her book is not a comprehensive survey; one that included global and Indigenous medical traditions (to name just a few) would be at least twice as long.

In contrast to the many histories of medicine that focus on practitioners, Bauer centers her narrative on the experience and treatment of disease, as well as the profound emotional, social, and economic impact illness can have on individuals and societies. Most chapters begin with a vivid vignette describing the symptoms, treatment, and possible explanation of a patient’s disease trajectory. These descriptions are occasionally based on historical accounts of specific patients, such as President James Garfield’s painful death in 1881 from a virulent infection caused by physicians using unsterilized means to remove an assassin’s bullet. Other vignettes concern a nonspecific “you,” inviting the reader to imagine themselves as a cholera patient or a parent of a child who suddenly takes ill and dies, despite attempts to keep them safe and healthy. Bauer occasionally includes comparative examples from her family’s 20th- and 21st-century experiences, reminding the reader that our contemporary understandings of health and illness are just as contingent on social, economic, political, and cultural circumstances as were the figures in her creative depiction of a 14th-century plague outbreak.

Medical practitioners are a part of this story, of course, as sources of explanations, health advice, and treatment innovations. Bauer emphasizes the influence of Hippocrates—the ancient Greek physician who wrote about the importance of maintaining humoral balance and equilibrium with one’s environment—on two millennia of physicians and political leaders across Europe, the Middle East, and eventually, the New World. She introduces us to the individuals who developed vaccines, antiseptic techniques, and antibiotics, describing how they sometimes faced personal and professional criticism or ostracization for their advocating new, ultimately life-saving, ideas and treatments. For example, Bauer profiles the obstetricians on both sides of the Atlantic Ocean who were puzzled by the epidemic of puerperal fever that caused otherwise healthy women to die after childbirth. In the United States in 1792, Alexander Gordon was horrified to discover that he was the culprit (along with several assisting midwives) who had been carrying “a deadly fever . . . from patient to patient.” Fifty years later, Ignaz Semmelweis noticed that women at the Vienna General Hospital died of puerperal fever far more frequently when they were attended by medical students who had often just come from autopsies, rather than midwives. Although he could not explain why, if the medical students washed their hands, women stopped dying after childbirth. Tragically, “for daring to suggest that medical students and doctors might be bearers of death, he lost his job and was ostracized by the Viennese medical community.” Semmelweis died of a septic infection after descending into alcoholism and depression.

Throughout the text, Bauer points to our recent experience of the COVID-19 pandemic as an argument for studying the history of illness in order to better understand our political and social responses to new diseases—and to guard against the racist and antisemitic language that persists in public conversations around illness and disease. She notes that our individual responses to COVID-19 were “repetitions of much older reactions to illness, replayed in the present with hardly any reference to how much more we now know.” She laments that “we were terrified of miasma, so we stood six feet apart. . . . we objected to the new vaccines because we didn’t understand the science.” On the political level, Bauer sees a “straight line from the imaginary Jewish well-poisoners of the 14th century” to Robert F. Kennedy Jr.’s 2023 suggestion of “COVID-19 as a Jewish-sponsored bioweapon.” She describes how President Trump’s repeated references to COVID-19 as “the Chinese virus . . . played into his already-existing strategy of pinning illness on immigrants,” as he consistently “repeat[ed] an old fear inspired by germ theory: that poor, uneducated, foreign immigrants are a particular threat to . . . white Americans.”

With vaccination rates falling and public health initiatives under siege in the United States, we need the kind of historical analysis that Bauer presents in The Great Shadow in order to understand not only how a resurgence of epidemic disease could affect all aspects of our lives, but also why age-old ideas about contagion, environment, infection, and personal responsibility remain powerful and compelling explanations for health and illness. Disease and sickness are inevitable human experiences, but Bauer hopes that understanding the past may help us respond to these distressing events in ways that do not exacerbate their impact or cause us to turn against each other.