Historian Samuel K. Cohn set out a decade ago to investigate the assertion that “epidemics … normally provoked hatred, blame of the ‘other’ and violence towards victims of the disease” (p. 1). At the time, the 2009 H1N1 influenza epidemic, sometimes referred to as Mexican flu, brought renewed public interest to the history of epidemics, in a cycle of recurring relevance familiar to many who work in medical history. Asked to write about blame and hatred in past epidemics, Cohn found his preliminary argument: influenza epidemics did not historically spur collective blame or violence. While that essay was not ultimately published, it launched Cohn’s larger research project. The resultant book, published in 2018, is an expansive survey of cultural responses to epidemic diseases from ancient to modern times. Cohn argues against the belief that epidemics routinely launched negative social reactions of hatred and blame, asserting instead that sources reflect “only a minority of epidemics that spurred hatred and violence against outsiders or insiders” (p. 2). While he does, in fact, find episodes of hatred, blaming and violence in connection with epidemics, he argues that they were neither ubiquitous nor predictable in their motives, spread or targets. Alongside this relative lack of collective negative reactions, Cohn also argues for epidemics’ “power to unite societies and inspire individuals and communities to extraordinary feats of compassion and abnegation” (p. 2).

Cohn’s study includes the most prominent epidemic diseases in history – plague, syphilis, smallpox, cholera, yellow fever, and influenza. hiv/aids is addressed in a short epilogue. Relying extensively on primary sources rather than secondary literature, Cohn argues that such episodes of collective blame and violence as can be found are not tied to a “pre-scientific” age with no explanations for epidemics with gruesome symptoms and/or high mortality (with the significant exception of the fourteenth-century Black Death). Instead, he finds greater evidence of public blame and collective violence in epidemics of the late nineteenth and twentieth centuries, the era in which he argues “the hate-disease nexus blossomed” (p. 160). Yet while Cohn shows that the rise of hatred and violence in response to disease was not tied to scientific understanding, he does not offer alternative explanations for it.

In search of social reactions to disease, Cohn retains a largely biological construction of these diseases, foregrounding them as historical forces which produce “social toxins” (p. 3) that shape people’s reactions to them. The book is divided into five chronological parts (Antiquity and the Middle Ages; Early Modernity; Modernity: Epidemics of Hate; Modernity: Plagues of Politics; Modernity: Plagues of Compassion), while each chapter within those parts remains focused on a single disease and the responses to it, thus retaining disease as the central organizing factor. Cohn does acknowledge differences in time and place, for example discussing cholera in Britain, Italy and America in separate chapters. But the foregrounding of disease is at times awkward, as, for example, when he finds that smallpox did not provoke blaming and violence in the ancient, medieval, or early modern eras but only “late in the day with the pandemic of 1881–82 in the US” (p. 532). Clearly it is not the disease but the social context that is important.

Cohn’s methodology is to rely on sampling primary sources rather than attempting to synthesize secondary literature. While he is to be commended for his exhaustive research into these sources, his presentation of case studies, at times, makes it difficult to keep track of his argument. In fact, through this long and winding journey across time and place, Cohn seems sometimes to be arguing different things. In his Introduction, he asserts that he is investigating the “scholarly consensus” that epidemics have always “provoked hatred, blame of the ‘other’, and violence towards victims of the disease.” (p. 1) By the Conclusion, however, he asserts that he has challenged the “dominant hypothesis… that mysterious diseases with no preventive measures or cures to hand were the ones to provoke ‘sinister connotations’, spurring hatred and blame towards ‘the other’ and victims of disease.” (p. 531) A small shift in focus, perhaps, but it’s a telling slip. He wants to argue that blame, fear and violence were not perpetual reactions, but, in many chapters, he brings to light previously unknown, understudied or underestimated violence. In Chapter 6: Plague Spreaders, he argues first that, in seventeenth-century Milan, blame and fear resulting from accusations of individuals as spreading plague deliberately was more extensive than official records suggest, which resulted in greater numbers of arrests, and a greater use of torture and execution than is often realized. His analysis of these events, however, focuses on contrasts with later cholera riots (which he argues were worse) and on what did not happen in Milan. Women were not accused, doctors were rarely the targets of rioting, no class conflict emerged. In analyzing plague spreading accusations and violence in sixteenth-century Toulouse, he asserts that “these trials and executions by burning alive cannot compete with the concurrent hysteria and brutality of witchcraft trials or with later waves of European cholera riots” (p. 159). Finding examples of blame, fear and violence, Cohn seems determined to diminish them as relatively inconsequential.

An all-encompassing survey such as this is a difficult task and critiques are inevitable of the author’s approach, argument, what he chose to include (and what was omitted). Cohn is nonetheless to be commended for undertaking such a survey and for bringing direct attention to the question of how people respond collectively to epidemics. It is a lens that has once again become relevant to current events, and Cohn’s book may well serve as a useful resource for other researchers who are taking a renewed interest in epidemics. Overall, Cohn is persuasive that blame, hatred, and violence did not inevitably occur in relation to epidemics; that premodern societies were no more likely to produce such responses than modern ones; and that the responses to epidemics in any era (and place) should be understood on their own terms, not as an exemplar of any universals. In addition, Cohn deserves recognition for his effort to call for more widespread attention to the positive social responses to epidemic crises.

On a final note, Cohn’s work, like many others published in recent years, has gained a new relevance with the emergence of the novel coronavirus in late 2019, and the ensuing global pandemic. Just as the assumptions, concerns and experiences of 2009 informed Cohn’s search through historical records, so current circumstances inevitably shape the experience of reading it. In particular, one realizes how easily social attitudes and responses may not appear in written records. We know that what gets recorded, both in popular and scholarly formats, depends on many contingent factors. While written records may tell us of large-scale acts of blame, violence, or compassion, they may not recount the collection of everyday small-scale events that shape individual lives. In the current pandemic, it becomes clear that hatred and compassion live side by side throughout everyday life, and that the manifestations of each are not motivated by the disease at hand, but rather by individual circumstances.