Reviewed by:

• A Modern Contagion: Imperialism and Public Health in Iran's Age of Cholera by Amir A. Afkhami
• Kim Clark (bio)

A Modern Contagion: Imperialism and Public Health in Iran's Age of Cholera By Amir A. Afkhami. Baltimore: Johns Hopkins University Press, 2019. Pp. 276.

How have international, national, and local forces shaped Iran's susceptibility to epidemics since the early nineteenth century? How did Iran's cholera outbreaks drive the adoption of new paradigms in medicine? And what role did changing infrastructures—not just water and waste systems, but trade routes, transportation, and telegraph technology—play in these processes? Afkhami addresses these questions and more in his wide-ranging history of public health, medicine, and politics in Iran from the 1820s to the 1920s.

A Modern Contagion is the result of two decades of assembling and mining archival materials and thinking deeply about them, drawing on the author's training as a physician and historian of medicine. It is a compelling narrative that sets the modernization of Iran's public health programs in the context of the global history of health.

The title captures well the multiple dimensions of the book's argument. The phrase "modern contagion" highlights how cholera spread due to conditions associated with Iran's position as a hub of intensifying population movements and trade in the nineteenth century. Internationally, endemic cholera in the Indian subcontinent was unlocked by global economic integration, allowing it to spill over to new regions. The book also traces a strong thread of argument about modern state formation and integration of regions in Iran. Increasing circulation of information about public health interventions, medical advances, and urban developments via telegraph and the printing press were also crucial in the emerging Iranian public sphere. Yet the underlying tension between the evolving secular medical and scientific knowledge and other ways of knowing the world took different forms in different moments and locations in Iran, so biomedical modernity did not have a unilineal trajectory in the country.

Imperialism framed Iran's experiences with epidemic disease and public [End Page 610] health in crucial ways. Located between British India, the Russian Empire, and the Ottoman Empire, with land and maritime borders with multiple neighbors, Iranian political and medical leaders had to navigate imperial rivalries over control of trade routes—with concrete consequences for their leeway in addressing disease outbreaks and operationalizing quarantines. These tensions also played out in Iran's participation alongside European colonial powers in the International Sanitary Conferences. The shifting contours of imperial pressures on Iran also manifested in changing constellations of foreign physicians and experts who led medical training in Iran, offered opportunities for Iranians to study abroad, and might have had the ear of Iranian rulers as their personal physicians.

Iran's century-long "age of cholera" was especially marked by periodic cholera outbreaks, but also by important epidemics of bubonic plague and Spanish influenza. Iran's broader history of medicine and public health involved multiple disease challenges that intersected with the changing political context through a period of state consolidation and secularization. Interestingly, among preventive health interventions, reform of water and waste systems during Iran's age of cholera came later than advances in large-scale vaccination programs.

Reading Afkhami's book as a historical anthropologist and Latin Americanist, this reviewer found it clear, readable, and stimulating for a non-specialist in the region. Yet some questions remain. The book sometimes seems to suggest that what constituted "progress" in medicine and public health was unambiguous, with phrases such as the "fate of progress suffered another setback" (p. 19). This underestimates the contested nature of science. As Iran was struggling to address cycles of infecto-contagious diseases, the causes, prevention, and treatment of those diseases were being debated and refined within medicine itself and were not just targets of external challenges (for instance, from religion). The strong emphasis on evolving public health dynamics at the national level may leave readers curious to know more about the local networks that actually carried out the health interventions...

审核人：

• 现代传染病：伊朗霍乱时代的帝国主义和公共卫生作者 Amir A. Afkhami
• 金·克拉克（生物）

现代传染病：伊朗霍乱时代的帝国主义和公共卫生作者：Amir A. Afkhami。巴尔的摩：约翰霍普金斯大学出版社，2019 年。Pp。276.

自 19 世纪初以来，国际、国家和地方力量如何影响伊朗对流行病的易感性？伊朗的霍乱疫情是如何推动采用新的医学范式的？不断变化的基础设施——不仅仅是水和废物系统，还有贸易路线、运输和电报技术——在这些过程中扮演了什么角色？阿夫哈米在他从 1820 年代到 1920 年代的伊朗公共卫生、医学和政治的广泛历史中解决了这些问题以及更多问题。

《现代传染病》是二十年收集和挖掘档案材料并对其进行深入思考的结果，借鉴了作者作为医生和医学史学家的训练。这是一个引人入胜的叙述，它在全球卫生史的背景下设定了伊朗公共卫生计划的现代化。

标题很好地捕捉了本书论点的多个维度。“现代传染病”一词突显了霍乱如何由于与伊朗在 19 世纪人口流动和贸易加剧的中心地位相关的条件而传播。在国际上，全球经济一体化解除了印度次大陆的地方性霍乱，使其蔓延到新的地区。这本书还追溯了关于伊朗现代国家形成和地区整合的强烈争论。在新兴的伊朗公共领域，通过电报和印刷机增加有关公共卫生干预、医学进步和城市发展的信息传播也至关重要。

帝国主义陷害伊朗在流行病和公众方面的经历[End Page 610]关键方面的健康。位于英属印度、俄罗斯帝国和奥斯曼帝国之间，陆地和海洋与多个邻国接壤，伊朗的政治和医学领导人不得不在帝国对贸易路线控制权的竞争中游刃有余——这对他们在应对疾病爆发和应对疾病方面的余地产生了具体影响。实施隔离。这些紧张局势还体现在伊朗与欧洲殖民大国一起参加国际卫生会议。帝国对伊朗施加压力的轮廓不断变化还体现在外国医生和专家在伊朗领导医学培训的变化，为伊朗人提供出国留学的机会，并可能将伊朗统治者的耳朵作为他们的私人医生。

伊朗长达一个世纪的“霍乱时代”尤其以周期性的霍乱爆发为标志，但也以重要的腺鼠疫和西班牙流感流行为标志。伊朗更广泛的医学和公共卫生历史涉及多种疾病挑战，这些挑战与国家巩固和世俗化时期不断变化的政治背景相交。有趣的是，在预防性健康干预措施中，伊朗霍乱时期的水和废物系统改革晚于大规模疫苗接种计划的进展。

这位评论家以历史人类学家和拉丁美洲学者的身份阅读了 Afkhami 的书，发现它对于该地区的非专家来说清晰、易读且具有启发性。然而，仍然存在一些问题。这本书有时似乎表明，医学和公共卫生领域的“进步”的构成是明确的，诸如“进步的命运遭受了另一次挫折”（第 19 页）之类的短语。这低估了科学的争议性。由于伊朗正在努力解决传染性疾病的循环问题，这些疾病的原因、预防和治疗正在医学本身内进行辩论和完善，而不仅仅是外部挑战（例如来自宗教）的目标。