This work - the latest in an epidemic of books on New World epidemics - is, as its title makes clear, aimed at a popular audience. Pinta - the name of a uniquely American disease as well as one of the trio of ships that carried the Columbian adventurers on their epic voyage of 1492 - is a treponemal disease. So is syphilis with which the author plays a game of cat and mouse. Like pinta, was it American in origin, or a new disease that burst upon Europe during the time of the Columbian voyages, or was it a newly mutated one? He toys in similar fashion with malaria; were there Africans in the New World before Columbus, and did they carry one or more of the malarial types with them so that they were on hand when the Europeans first arrived?

Such speculations can be entertaining, and the author, a retired professor of tropical medicine and medical microbiology (and currently an adjunct professor of epidemiology) has excellent credentials for probing medical matters. There are, however, occasional problems with the history - a least for a Caribbean historian. On page 53, for example, he seems unaware that the Lucayans, the first peoples encountered by Columbus, were of the Arawak linguistic family. He calls the Arawaks (now better thought of as Tainos) "simple" when contrasted with the inhabitants of other islands; yet the Tainos were the most sophisticated and civilized of the indigenous Caribbean populations. On the next page, Columbus in returning from his first voyage makes an "embarrassed landfall at Lisbon" without mention of the intense storm (some have said a cyclone) that fell upon the Nina after leaving the Azores - a storm which literally drove the ship into the Tagus estuary. Geographers too may wonder at a slip on page 138, where Cuba becomes Hispaniola.

The author sometimes sketches imaginary scenarios to show how diseases may have been shuttled between the Old World and the New. A sailor, for example, contracts syphilis in the Americas and carries it to Europe; a young African male sold into slavery makes the middle passage in the hold of a slave ship alive with African ailments ricocheting about.

About mid-way through the book readers learn that they are to be confronted by more (or less) than disease exchanges. In chapter 6 there is an abrupt shift from epidemiology to European medical history and the discovery of germ theory, whereas chapter seven focuses on American medical history and the unraveling of the mysterious etiology of yellow fever in Cuba. Yellow fever and the Panama Canal come next, followed by the Rockefeller campaigns to eradicate hookworm and yellow fever. In chapters 10 and 11 the point is made that tropical disease can do very nicely indeed in temperate climates as the history of malaria is explored in first the United States and then in England.

The final two chapters get back to (now modern) disease exchanges. In chapter 12 the pig tapeworm and Chagas disease, both of which have reached the United States with Latin American immigrants, become today's examples of yesterday's phenomenon of pathogens traveling in the blood and bowels and on the breath of the European and African immigrants, which the author earlier implied, wiped out 90 percent of the native American population.

The last chapter forecasts that the twenty-first century will probably prove hazardous to our collective health. In addition to the usual dangers of global warming there is the encouragement that sultry temperatures give to parasitic proliferation. This, coupled with increasing human pressure on, and contact with, the globe's receding rainforests may mean that diseases such as AIDS, Ebola virus fever and the like are only the leading edge of a pathogenic hurricane already building just beyond the horizon.

Despite disease and death occupying center stage one suspects that this book was fun to write and it certainly was fun to read. Desowitz writes well and with considerable enthusiasm and wit. His globe-trotting medical career has provided material for a running first-hand commentary of many of the cities and countries described, and the text and footnotes are packed with anecdotes and medical "war-stories." Finally, however, these pages contain a somber message. Although, at least for residents of developed countries, epidemic diseases were in recession from the influenza pandemic of 1918 until the relatively recent AIDs outbreak, those halcyon days clearly are gone.

Kenneth F. Kiple Bowling Green State University

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