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# Man vs. Infectious Disease
- URL: https://mereorthodoxy.com/man-vs-infectious-disease/
- Published: 2026-09-04T11:00:02.000Z
- Updated: 2026-09-04T11:00:01.000Z
- Description: The history told in 'The Great Shadow' is vast but incomplete.
- Author: Mere Orthodoxy
- Tags: Journal, Summer 2026, Health & Medicine, Book Reviews, Culture, Matthew Loftus

**Susan Wise Bauer.** [***The Great Shadow: A History of How Sickness Shapes What We Do, Think, Believe, and Buy***](https://us.macmillan.com/books/9781250272911/thegreatshadow/?ref=mereorthodoxy.com)**. St. Martin’s Press, 2026\. $30.00\. 352 pp.** 

Death from infectious disease feels wrong to us in the twenty-first century. Such deaths are rare enough in developed, wealthy countries to make headlines or launch inquiries after they happen to young, otherwise healthy people—because they are often preventable. Such deaths do not happen every day in my work at a mission hospital in rural Kenya, but when they do, almost always one can identify the point where the system broke down and a preventable death became inevitable. 

This feeling of wrongness is the result of what scholars call the Second Epidemiological Transition—the massive changes in quality and length of life brought about by modern medicine, mostly in the first half of the twentieth century. Before antibiotics and vaccines, deadly infectious diseases lurked everywhere and inspired all sorts of human efforts to prevent or cure them. Susan Wise Bauer’s new book *The Great Shadow: A History of How Sickness Shapes What We Do, Think, Believe, and Buy* catalogues these efforts and attempts to put them in context as we ride the wave of the Third Epidemiological Transition—our modern era of antibiotic resistance and mutated viruses.

Bauer, the founder of Well-Trained Mind Press and author of the *Story of the World* books used by millions of homeschoolers, is well-equipped to tell the story of sickness. *The Great Shadow* joins recent releases like John Green’s *Everything is Tuberculosis* and Timothy Winegard’s *The Mosquito* as a history of human culture examined through the lens of infectious disease, taking readers through thousands of years of humans trying to figure out how to prevent and treat infections. The threat of infection and death is life-altering, as Bauer writes:

Sickness is not “just” sickness. Sickness is the most intimate expression of our vexed relationship with reality, the place where smooth functioning suddenly fractures and spins apart without warning. Sickness is the great mirror that reflects back our most urgent question: *Why does calamity descend without warning? How can we explain it? How do we avoid it? How do we fight back?*

As a historical catalogue of maladies and our reactions to them, Bauer has assembled a solid (if somewhat incomplete) narrative. However, whenever the book tries to draw contemporary parallels, it generally falls flat, detracting from an otherwise fascinating story. The story of sickness is much bigger than infectious disease, and the wisdom of human response to infections is more complicated than Bauer seems willing to give people credit for.

## How Sickness Shapes Us

*The Great Shadow* begins with the First Epidemiological Transition, when humans started living together in static settlements and made themselves vulnerable to all kinds of viruses, bacteria, fungi, and parasites that hunter-gatherers eluded by virtue of their migratory lifestyle. Irrigation required standing water, domesticating animals allowed new infections to jump from species to species, and managing our bodily waste became a perennial issue. Ancient myths from places as diverse as Mesopotamia, China, and West Africa told just-so stories linking settled, agricultural civilization with the rise of disease. The tone is overly dramatic; the best way to describe it is as if Bauer has written the script for a documentary. For the most part, this approach works but at times it is tiring. 

Disease raised spiritual and moral questions, as people assumed that there must be a cause for every effect. From the Biblical book of Job to the Epic of Gilgamesh, humans began to tie guilt and blame to the existence of illnesses and found ways as diverse as priestly dreams to studying animal entrails to find the why. *The Great Shadow* frequently returns to the idea of human responsibility, seeing it as a thread that ties together many different human responses to sickness. While acknowledging that there are some sicknesses that are indeed the fault of the sick person, repeatedly the book shows examples where blame was unfairly placed throughout history.

This idea only intensifies as the book turns to Hippocratic medicine, which explained sickness as an imbalance of humors within the body and saw miasma (“bad airs”) as a critical piece of the disease puzzle. The bottom line for Hippocratic medicine (which came to dominate the culture of medicine for thousands of years) is, in Bauer’s words: “More than ever before, *illness is your fault.*” (Emphasis in the original.) *The Great Shadow* argues that this idea is still with us: “Striving for wholeness and balance, for moderation and temperance: these all seem like worthy goals to us. But we have carried over, from Hippocratic times, a complicated and lingering sense of failure when our lives do not flow with ease.”

Medieval pogroms took the idea of blame to another level, blaming Jews for various illnesses and then carrying out violence against them. This idea recurred with even deadlier consequences in the Nazi regime, which Bauer places in a “straight line” leading to conspiracy theories about COVID-19 as a Jewish bioweapon. Similarly, the story of “Typhoid Mary” still animates contemporary fears about foreigners carrying illnesses.

As humans got closer and closer to scientific facts about microorganisms causing disease, they often came into conflict with the reigning theories about balancing humors and clearing miasma. Ignaz Semmelweiss was hounded into a mental asylum by his contemporaries after calling for his fellow doctors to sterilize their hands between autopsies and delivering babies, while intense debates broke out about the wisdom of vaccination.

What seems like common sense to us was the result of hard-fought battles—battles that Bauer argues we are still fighting today. She makes the case that because miasma theory was still predominant well into the Second Epidemiological Transition, a number of products we still use today (such as plug-in air fresheners and Listerine) are still in use because “our noses have inherited the nineteenth-century fear of miasma.”

*The Great Shadow* concludes by taking readers through the brief “exhilaration” of antibiotics and vaccines that was almost immediately deflated by the emergence of antibiotic-resistant bacteria, novel viruses like HIV and Ebola, and cultural works like *Night of the Living Dead* or *The Last of Us* that use zombies as a metaphor for our fears about contagion. In the book’s conclusion, Bauer argues that the response to COVID-19 (particularly in the U.S.) “replayed, unthinking, almost every beat of the last few centuries of our relationship with infectious disease.” And while “\[s\]ome of these reactions might well have been sound and well-considered,” she argues that “\[m\]ost were not.” Six-foot distancing represented our fear of miasma, fearing immigrants repeated the ugly patterns of blame from the past, and the overuse of sanitizing agents made us too much like the Victorians of the past.

*The Great Shadow* ends with a somewhat hopeful note that understanding this history will help answer the question whether, during the next big pandemic, we will or won’t “coat ourselves in chemicals, rail against bodies that don’t look like ours, and accuse scientists of corruption?” This is Bauer’s apparent purpose: in order to prevent reactions that are not “sound and well-considered,” we must appreciate how some of these irrational responses are deeply hard-wired into human culture.

## Blame and Responsibility

Bauer’s primary assumption is true: sickness really does force us to confront a number of existential realities and the brokenness within our world. However, the apparent secondary thesis, that guilt and blame (as well as other misunderstandings) have inappropriately lingered in our social imaginary is not as straightforward as she makes it out to be.

*The Great Shadow* is not really about sickness in general; it’s mostly about *infectious* diseases caused by foreign microorganisms. Only the chapters about painkillers and hysteria dwell at any length on non-infectious diseases. A history of all sickness would be much longer and far more complicated, for there are many diseases that are *not* caused by infections and some that hew more closely to Hippocratic ideals and miasma theory. Both of these ideas—indeed, nearly all of the reactions and behaviors that Bauer describes—contain a kernel of truth. Bauer readily concedes this point but does not ever really let it refine her thesis.

Air pollution, for example, is estimated to be responsible for millions of deaths worldwide every year. To eliminate these deaths would simply take cleaning up the air and improving household ventilation, since cleaning circulated air is valuable in preventing both infectious and non-infectious diseases. Some studies suggest that retrofitting school buses can even improve students’ academic performance! Whether “blame” is the correct frame for air pollution is a debate for a different space, but certainly we must as a society figure out where the pollution is coming from. Regulating and occasionally punishing its producers would also help.

There are a few other notable gaps in the story. Sexually transmitted infections have been identified as such for over 500 years, and the politics of blame around HIV get only a passing mention in the book. The Tuskegee Syphilis Study, in which the government was very much to blame for allowing a disease to destroy vulnerable people, is not mentioned at all. The history of eugenics might have fit in as well, given the significant overlap between the scientific consensus about the spread of germs and health authorities’ approach to genetic causes of disease a century ago.

I do not know when exactly the book went to press, but even the story *The Great Shadow* tells about COVID-19 is not as simple as it sounds. The US government was funding gain-of-function research (a fascinating response to the specter of infectious diseases worthy of discussion in and of itself) in Wuhan, and many of the government’s earliest critics were right to smell a conspiracy when Dr. Anthony Fauci claimed otherwise. Given the possibility that the Chinese Communist Party’s cover-up of the disease may have cost millions of lives, pointing some fingers and assigning responsibility is eminently reasonable.

When it comes to responsibility, Bauer mixes straightforward reporting about past misunderstandings of hysteria and “the passions” with criticism of diagnoses that shifts any responsibility for getting better onto the sick person themselves. Yet psychosomatic illnesses (that is, illnesses that are thought to be due to a patient’s internal or psychological stress manifesting as physical symptoms) are estimated to make up 20% of visits to primary care doctors. The most rigorous scientific studies about chronic pain suggest that the patients who do better are the ones who take the most responsibility for their own wellness, as Haider Warrach’s book *The Song of Our Scars* discusses carefully.

While miasma theory only reflects a half-truth about illness (and, as *The Great Shadow* details, a lot of the work to cleanly dispose of sewage was the right thing for the wrong reason), Hippocratic medicine endures because it reflects truths about our bodies and souls: Patients want to feel like their lives are balanced, nutrition and exercise are key factors in preventing chronic diseases, and our environment (whether it’s clean air or a walkable neighborhood) does have a role to play in our health. The lesson to learn from Hippocrates’ staying power beyond the Second Epidemiological Transition is one that Bauer doesn’t seem to find of interest: while many aspects of our health are indeed beyond our control, there’s still a lot that we can do to find balance and wholeness.

## In the Shadow of the Great Physician

Most importantly, though, none of the reactions that *The Great Shadow* discusses seem like positive developments for human culture. As Lydia Dugdale discusses in her must-read book *The Lost Art of Dying*, the possibility of death and disease made our ancestors far more careful about not only dying well but also living in such a way that they were ready whenever death might come. It is certainly possible to allow fear of sickness and blame (of others or of ourselves) for infections to lead to atrocities—but there is a far richer history of love and care to be found in traditions like the *ars moriendi* that forms the focus of Dugdale’s book.

One omission from *The Great Shadow* that would illuminate this sort of love and care is the story that Rodney Stark details in his book *The Rise of Christianity*. Christians in the third century, facing a deadly plague, did not run or blame foreigners. Rather, they sacrificed themselves to care for their pagan neighbors. So began a tradition of medical care despite the risk of infection that endures to the selfless heroism of health professionals (Christian and otherwise) who rush to “hot zones” of Ebola epidemics nowadays. The capricious nature of the gods in ancient times gave way to Francis Bacon’s insistence that God gave us technology to relieve pain and suffering—an enormous part of what we think and believe now that we count history by the life and death of the Great Physician.

*The Great Shadow* is, of course, coming out at a time when America’s own Secretary of Health and Human Services may not actually believe in germ theory and many people are in need of an anti-miasma correction. Some have made the ideals of Hippocratic medicine into a story of karma that unnecessarily heaps blame and shame on suffering people. However, as we have seen throughout the COVID-19 pandemic and elsewhere, telling only parts of the story will continue to engender the sort of responses that are harmful to others. The history told in *The Great Shadow* is vast but incomplete, telling the truth about the ugliest aspects of human encounters with infectious disease while leaving out the ways in which our awareness of fragility became a light that chased the shadows away.