Instant Ebook Access, One Click Away – Begin at ebookgate.

com

Anthropology of Infectious Disease 1st Edition

Merrill Singer

https://ebookgate.com/product/anthropology-of-infectious-
disease-1st-edition-merrill-singer/

OR CLICK BUTTON

DOWLOAD EBOOK

Get Instant Ebook Downloads – Browse at https://ebookgate.com

Click here to visit ebookgate.com and download ebook now
Instant digital products (PDF, ePub, MOBI) available
Download now and explore formats that suit you...

Neuropsychology of cardiovascular disease Second Edition

Merrill F. Elias

https://ebookgate.com/product/neuropsychology-of-cardiovascular-
disease-second-edition-merrill-f-elias/

ebookgate.com

Diagnostic Pathology of Infectious Disease Richard L.

Kradin

https://ebookgate.com/product/diagnostic-pathology-of-infectious-
disease-richard-l-kradin/

ebookgate.com

Immunology and Evolution of Infectious Disease Steven A.

Frank

https://ebookgate.com/product/immunology-and-evolution-of-infectious-
disease-steven-a-frank/

ebookgate.com

Clinical Infectious Disease 2nd Edition David Schlossberg

https://ebookgate.com/product/clinical-infectious-disease-2nd-edition-
david-schlossberg/

ebookgate.com
Mims Pathogenesis of Infectious Disease Sixth Edition
Anthony A. Nash

https://ebookgate.com/product/mims-pathogenesis-of-infectious-disease-
sixth-edition-anthony-a-nash/

ebookgate.com

Infectious Disease Surveillance Second Edition Nkuchia M.

M'Ikanatha

https://ebookgate.com/product/infectious-disease-surveillance-second-
edition-nkuchia-m-mikanatha/

ebookgate.com

Infectious Disease Surveillance 2nd Edition Nkuchia M.

M'Ikanatha

https://ebookgate.com/product/infectious-disease-surveillance-2nd-
edition-nkuchia-m-mikanatha/

ebookgate.com

Infectious Disease Management in Animal Shelters 1st

Edition Lila Miller

https://ebookgate.com/product/infectious-disease-management-in-animal-
shelters-1st-edition-lila-miller/

ebookgate.com

Treatment of Pediatric Neurologic Disorders Neurological

Disease and Therapy Volume 68 1st Edition Harvey S. Singer

https://ebookgate.com/product/treatment-of-pediatric-neurologic-
disorders-neurological-disease-and-therapy-volume-68-1st-edition-
harvey-s-singer/
ebookgate.com
Anthropology of Infectious Disease
Honoring his landmark contributions to the anthropological study of infectious
disease and to the biocultural synthesis that has guided such work, this book is
dedicated to the memory and inspiration of George J. Armelagos, 1936–2014.
 Merrill Singer

The
anthropology
of
infectious
disease

Walnut Creek
CAlifornia
 Left Coast Press, Inc.
1630 North Main Street, #400
Walnut Creek, CA 94596
www.LCoastPress.com

Copyright © 2015 by Left Coast Press, Inc.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system,
or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or
otherwise, without the prior permission of the publisher.

ISBN 978-1-62958-043-2 (hardback)

ISBN 978-1-62958-044-9 (paperback)
ISBN 978-1-62958-045-6 (institutional ebook)
ISBN 978-1-62958-046-3 (consumer ebook)

Library of Congress Cataloging-in-Publication Data

Singer, Merrill.
Anthropology of infectious disease / Merrill Singer.
  pages cm
Includes bibliographical references and index.
ISBN 978-1-62958-043-2 (hardback)—
ISBN 978-1-62958-044-9 (paperback)—
ISBN 978-1-62958-045-6 (institutional ebook)—
ISBN 978-1-62958-046-3 (consumer ebook)
1. Communicable diseases. 2. Medical anthropology. I. Title.
RA643.S56 2015
616.9—dc23
2014030349

Printed in the United States of America

∞ ™ The paper used in this publication meets the minimum requirements of American
National Standard for Information Sciences—Permanence of Paper for Printed Library
Materials, ANSI/NISO Z39.48–1992.

Cover design by Piper Wallis

Cover photo by Laura R. Wagner
Contents

List of Illustrations 7

Acknowledgments 9

Introduction
Anthropology and the Large Impact of Small Worlds 11

Chapter One
Defining the Anthropology of Infectious Disease: Toward a Biocultural/
Biosocial Understanding 20

Chapter Two
Denizens of the Microbial World 60

Chapter Three
More Than Human 101

Chapter Four
Environmental Disruption, Pluralea Interactions, and Infectious
Diseases 125

Chapter five
Emergent, Reemergent, and Drug-Resistant Infectious Agents 156

Chapter Six
Infectious Disease Syndemics 196

Chapter Seven
Inequality, Political Ecology, and the Future of Infectious Diseases 225

Glossary 267
References 284
Index 315
About the Author 320
Illustr ations

Figures

Figure I.1 19th century illustration of Herpes gladiatorium skin

infection 12
Figure 1.1 Early 20th century photo of urban poverty entitled “A
Consumptive Mother and Her Two Children at Work” 43
Figure 1.2 Aegypti mosquito lava in research laboratory 50
Figure 1.3 Physician in the Philippines being instructed about the Aedes
aegypti mosquito 54
Figure 2.1 Stromatolites in Australia 62
Figure 2.2 Centers for Disease Control measles immunization poster 71
Figure 2.3 Staphylococcus 79
Figure 2.4 Sucking Anopheles mosquito 89
Figure 2.5 1960s public health message 96
Figure 3.1 Trichinella spiralis, a parasitic worm 106
Figure 3.2 HIV testing in Lesotho in Southern Africa 113
Figure 3.3 Human immunodeficiency virus 114
Figure 4.1 Schistosomiasis prevention poster 129
Figure 4.2 Access to clean water is a significant factor in infectious risk:
Lesotho in Southern Africa 130
Figure 4.3 Tripartite model of biosocial penetration 131
Figure 4.4 Risk of water-borne infectious diseases 132
Figure 4.5­  Water-borne disease routes, dog drinking from dishwashing
bucket at open air market in Quito, Ecuador 142
Figure 4.6 Urban breeding ground for infectious diseases, Cite Soleil,
Haiti 144
Figure 4.7 Wall mural on cholera epidemic in Haiti 145
Figure 4.8 Cholera prevention billboard in Haiti 146
Figure 4.9 Pathogenic agent of bubonic plague 154
Figure 5.1 Smallpox vaccination 158
Figure 5.2 Polio eradication campaign, Kolkata, India 159
Figure 5.3 Oral poliovirus vaccine administration 161
Figure 5.4 1940s malaria control in Teheran, Iran 165
Figure 5.5 Infectious disease researcher, Iquitos, Peru 168
Figure 5.6 X-ray of Mycobacterium tuberculosis infection X-ray 170
Figure 5.7 Unrefrigerated meat for sale in open air market in Quito,
Ecuador 175
Figure 5.8 In the midst of the cholera epidemic crabs for sale in the open air
market in Quito, Ecuador 183
Figure 6.1 Influenza and tuberculosis prevention poster, Rensselaer
Country Tuberculosis Association 202
Figure 6.2 The SAVA syndemic 214
Figure 6.3 Injection drug use emerged as an important route of HIV
infection 216
Figure 7.1 Prevention poster used in theaters in Chicago during the 1918
influenza pandemic 251
Figure 7.2 Biosafety Level 4 infectious disease laboratory worker wearing
protective gear 254
Figure 7.3 Cutaneous anthrax lesions on a man infected with the
bacterium Bacillus anthracis 256

Tables

Table 1.1 Components of the anthropology of infectious disease 37

Table 2.1 Pathogenic sources of various diseases 68
Table 3.1 Tickborne diseases of the U.S. 116
Table 4.1 Infectious diseases that are spreading because of global
warming 135
Table 5.1 Pathogens studied as possible agents for use in biological
warfare 193
 9

Acknowledgement

Deep appreciation is extended to Jennifer Collier Jennings, my editor at Left

Coast Press. I would be a very rich man if I had a dollar for all of the suggested
changes she provided for this book.
 11

Introduction

Anthropology and the Large

Impact of Small Worlds

Breathe in. Feel the air pass through your nostrils and move into your
nose. Your diaphragm contracts, pulling the air deep into your chest.
Oxygen floods into tiny cavities in your lungs and travels into your
capillaries, ready to fuel every cell in your body. You’re alive. So is that
breath you just took. When we inhale, our nostrils capture millions of
invisible particles: dust, pollen, sea spray, volcanic ash, plant spores.
These specks in turn host a teeming community of bacteria and viruses.
Nathan Wolfe, microbiologist (2013)

W
ith these words, Stanford microbiologist Nathan Wolfe, founder of
Global Viral and author of The Viral Storm, draws attention to the
intimate relationship between our species and a host of tiny organ-
isms, most too small to see with our own eyes, a relationship “we still understand
precious little about” (Wolfe 2012). Humans have been keenly aware of the exis-
tence of microorganisms since the invention of the microscope about 350 years
ago; long before that some people suspected their existence. But we discovered
some forms of microbes, such as viruses, little more than a century ago, and only
much more recently are we beginning to appreciate fully their abundance and
complex variety, the diverse niches they occupy in almost all environments,
their natural ecology, and the full role they play in human health. In fact, we
now believe that all life forms on Earth, including humans, are descendants of
microbes called Archaea, or “ancient ones.” Archaea are still around in some
unexpected locations—volcanic vents on the ocean floor, for example.
Just how important are microbes? Microbes are responsible for producing
about half of the oxygen we need to survive (plants account for much of the
rest of it). Within the human body they are more numerous than human cells.
Each of us is more than a distinct individual—we are composed of an internal
community of organisms that function together in various forms of mutual de-
pendency. Although most of the microbes inside of us have little or no impact on
us (that we have yet discovered), some, as we will see in Chapter 2, help us digest
food, absorb nutrients, produce needed vitamins, yield vital anti-inflammatory

Anthropology of Infectious Disease, by Merrill Singer, 11–19. © 2015 Left Coast Press, Inc. All rights reserved.
12 ❋ in t ro duc t io n

proteins, protect our skin, and serve other body functions that contribute to
human well-being. In return, we have a lot to offer microbes:

A human host is a nutrient-rich, warm, and moist environment, which

remains at a uniform temperature and constantly renews itself. It is not
surprising that many microorganisms have evolved the ability to survive
and reproduce in this desirable niche (Albers et al. 2004:1486).

Of course, our commune with microbes is not all mutual affection. In

the pages of National Geographic, a magazine that brims with pride over the
triumph of the human species over every corner of the planet and even into
outer space, Nathan Wolfe offers this more ominous assessment: “behind our
world is a shadow world of microbes—and they are often calling the shots”
(2012). Some microbes—a fairly small percentage, actually—are pathogenic:
they cause human diseases or diseases of other species that may evolve to affect
humans. Infectious pathogens, or disease-causing organisms, include some
types of viruses, bacteria, fungi, and protozoa as well as multicellular parasites
and an aberrant set of proteins known as prions. Despite their miniscule size
and relatively small number of varieties, the toll they take on human life and
well-being is staggering (see Figure I.1).
Worldwide, infectious diseases are the leading cause of death of both children
and adolescents and one of the leading causes of death in adults. They have
claimed hundreds of millions of human lives throughout history and remain
primary sources of morbidity and mortality globally, especially in developing
countries but also in highly developed industrial countries. Of the top ten

Figure I.1 19th Century illustration of Herpes gladiatorium skin infection.

(Image from the History of Medicine)
 anthropology and the large impact of small worlds ❋ 13

causes of death in the world, three are infectious diseases; these account for
about 16 percent of all deaths each year (Center for Strategic and International
Studies 2012). Consider just one of the infectious diseases discussed in this
book: tuberculosis. The World Health Organization (2011) estimates that the
microorganism that causes tuberculosis infects one person in the world every
second and that every twenty seconds one person dies as a result. This microbe
travels by air; other pathogenic microbes have evolved an array of strategies
for transmission. For example, rabies, which humans have contended with for
millennia, is spread through the bites and scratches of infected animals. Our
understanding of microbes may be recent, but we have long understood this
route of disease transmission: written descriptions of how to control the spread
of this disease date to more than three thousand years ago (Albers et al. 2004).
Unfortunately we are discovering new infectious diseases every year.
Among the most important new diseases of the twentieth century, of course,
is HIV disease. So far I have distinguished the microbe that causes a disease
from the disease itself, but in reality the dividing line between the infection
by a pathogen and the disease that develops is arbitrary. I use the term “HIV
disease” to avoid imposing an artificial line between infection with the HIV
virus and the development of a disease called AIDS. A growing list of other
emergent and reemergent infectious diseases includes the well-publicized severe
acute respiratory syndrome (SARS), swine flu, and avian flu. A few new infectious
diseases, notes anthropologist George Armelagos, are “so bloodcurdling and
bizarre that descriptions of them bring to mind tacky horror movies. Ebola
virus, for instance, can in just a few days reduce a healthy person to a bag of
teeming flesh spilling blood and organ parts from every orifice.” After decades
of believing that we would triumph over infectious disease, treatment-resistant
infections, covered in Chapter 5, have significantly heightened public concern
about infectious diseases in the contemporary world. In the United States infec-
tious diseases killed 58 percent more people in 1992 than in 1980 (Armelagos
1997:24). The impact of infectious diseases in the United States has continued
to grow since then. As stressed by the Institute of Medicine (Smolinski, Ham-
burg, and Lederberg 2003:21),

Infectious diseases unknown in this country just a decade ago, such

as West Nile encephalitis and hantavirus pulmonary syndrome, have
emerged to kill hundreds of Americans—and the long-term consequences
for survivors of the initial illnesses are as yet unknown. Other known
diseases, including measles, multi-drug-resistant tuberculosis, and even
malaria, have been imported and transmitted within the United States
in the last 10 years.
14 ❋ in t ro duc t io n

New research on the relationship between the environment and health is

enhancing our understanding of infectious disease. Global warming, for example,
contributes to the spread of water-borne and vector-borne infectious agents (see
Chapter 4). Researchers are also taking a more multidimensional approach fo-
cused on syndemics, which entails examining pathogenic microbes not only in
isolation but also in their complex relationship to other, noninfectious diseases
and sociocultural and economic conditions, such as poverty. The conceptualiza-
tion of syndemics, examined in Chapter 6, was a major contribution of medical
anthropology that has diffused to other health-related disciplines in recent years.
Of particularly keen interest to anthropology is the way in which diverse
human behaviors contribute directly and indirectly to the threat pathogens
pose—we are overdosing on antibiotics, changing the planet’s climate, occu-
pying new terrains, developing new residence patterns, and adopting new food
production and handling strategies. Consequently, as Wolfe (2012) stresses,

As we learn more about the relationships between ourselves and our mi-
crobes—and their own complex relationships with one another—scientists
are coming to see the microbiome the way ecologists have long viewed an
ecosystem: not as a collection of species but as a dynamic environment,
defined by the multitude of interactions among its constituents.

In other words, infectious diseases are never only biological in their nature, course,
or impact. What they are and what they do are deeply entwined with human
sociocultural systems, including the ways humans understand, organize, and
treat each other (see, in particular, Chapter 7). Infectious diseases are at once
biological realities and social constructions that reflect both biological and
social relationships and interactions. Ultimately, in spite of our ingrained habit
of treating them as distinct and even opposing forces, biology and culture are
inseparable. This fact makes anthropology particularly well suited to understand
and generate key insights about infectious disease.
Consider again HIV disease. As we all know, biomedical treatments for this
condition have improved enormously over the last thirty years, contributing to
astonishing advances in the health of people living with the disease. Yet three
stubborn challenges endure:

• People are often diagnosed late and, as a result, cannot receive the optimal
benefits from existing antiretrovial therapies.
• For various reasons, some people drop out of treatment.
• Some people are uneven in their adherence to day-to-day treatment
requirements.
 anthropology and the large impact of small worlds ❋ 15

Why? Leading HIV researchers explain: “Although an emphasis on testing

and treatment sounds primarily biomedical, the three challenges depend on
behavioral, social system and [social] structural factors” (Morin et al. 2011:175).
Nevertheless, the vast majority of researchers and research dollars are still
focused on the biological aspects of infectious diseases rather than the ways
their emergence and spread reflect human activities, modes of production and
residence, beliefs and attitudes, governance and structures of social relation,
and environmental transformations.
Given their significant and enduring role in human life and death—and
hence their influence on human societies both subtle and monumental—in-
fectious diseases have become an important concern within anthropology,
particularly in the subfield known as medical anthropology. This book explores
the nature of infectious diseases and how our coexistence with them shapes the
human condition, contributing in ways small and large to making us who we
are biologically, culturally, and socially as well as influencing our individual
life experiences. As increasing numbers of medical anthropologists study
biocultural and biosocial processes in health, illness, and treatment, including
environmentally mediated factors in human health and well-being, they are
generating important new concepts and research questions. This book explores
these intriguing questions on the frontier of infectious disease research:

• How does the human world look different if we move beyond thinking
of human communities as collections of interacting people and instead
recognize that we live in multispecies communities that include disease
vectors and zoonotic pathogens that regularly “jump” from animal hosts
to humans?
• How does our understanding of ourselves change if we recognize that
every person is, in fact, a community of interacting species?
• How does our conception of health change if we think of health not as an
individual state but instead as a reflection of human social relationships
mediated by the environment?
• Why, in an era of miraculous improvements in health interventions,
do infectious diseases remain the leading cause of death in developing
nations?
• Why, even in highly developed and comparatively wealthy nations with
advanced and costly medical systems, such as the United States, are
infections the third leading cause of human mortality?
• How do human activities and understandings (e.g., cultural conceptions
of “plague” and stigmatization) contribute to the spread of infectious
16 ❋ in t ro duc t io n

diseases, the emergence of new infectious diseases, the course of infec-

tious disease epidemics, and the magnitude of human suffering?
• How are broader forces of globalization likely to affect the spread of
infectious diseases and their overall health consequences?
• How are our cultural understandings of disease changing through time,
and how will these changes affect social responses to infectious disease?
• How does anthropology contribute to the understanding of the role of
infectious diseases in human communities?

This book advances an anthropologically framed approach to disease and

contagion transnationally by integrating the natural history of infection with
human social behavior and structures of social relation. It is informed by eco­
social theory, a term coined by epidemiologist Nancy Krieger (2007) to describe
a multilevel framework that integrates social and biologic reasoning along with
a dynamic, historical, and ecological perspective to understand population
distributions of disease and social inequalities in health. To this framework, an-
thropology brings evolutionary depth, investigating humans as a species that has
evolved in constant interaction with other species; an ethnographically informed
focus on the processes and pathways of biocultural and biosocial interaction;
and a growing focus on the interface of local sociocultural and environmental
settings with wider fields of social force and exchange in a globalizing world.
In recent years the anthropological approach has demonstrated its value
to understanding and responding to HIV, ebola, SARS, tuberculosis, malaria,
influenza, kuru, and numerous other infectious diseases by analyzing their
role in the creation of lived experiences and as reflections in physical bodies
of conflicts and points of tension in social bodies as well as by identifying and
assessing human behaviors linked to prevention and treatment. Anthropology
can nest everyday, on-the-ground activity within the encompassing frame of
social groups and communities and, beyond this, within the big picture of global
processes and international social relationships. Its scope broadens even further
to explore the linkages—not readily apparent yet critically important—between
microscopic entities and the political and economic structures of human societ-
ies by identifying the pathways that connect human bodies, cultural and social
systems, and health.
The anthropological approach to HIV disease demonstrates its particular
contribution to the larger multidisciplinary study of infectious diseases. Inter-
national health programs invest considerable effort into two areas. First, they
examine risk behaviors, focusing on individuals as rational decision makers and
interpreting behavior as a direct outcome of an individual’s characteristics or
capacities. For example, whether someone is likely to engage in sexual behaviors
 anthropology and the large impact of small worlds ❋ 17

considered more risky for contracting HIV is analyzed in terms of an individual’s

characteristics, like sexual orientation, knowledge, attitudes, and perceived ability
to prevent infection. Second, they look at the structural vulnerabilities of entire
populations, such as the role of poverty in risk behavior. By contrast, one impor-
tant focus of anthropology has been the relationship between individual agency
and structural factors in health. This is the level that encompasses social groups,
interpersonal networks, and communities. Moreover, anthropologists move
beyond the simplistic understanding of individuals as rational decision-making
agents, recognizing instead that people’s behaviors are not the direct product
of their individual characteristics, decisions, or capacities; behavior, including
action that puts people at risk of infection, “is always itself social, imbued with
meaning, rich in significance, and the outcome of a variety of forces” (Kippax et
al. 2013:1368). One of those forces is people’s involvement in social groups, which
are critical influences on their identities, values, knowledge, health status, and
activities. For example, groups that view the primary role of sex as procreation
do not receive favorably public health messages promoting the use of condoms
to prevent HIV infection. Group membership also mediates awareness of and
attitudes toward particular infectious diseases as well as appropriate behaviors
to avoid or treat them, however they are understood, which may have nothing to
do with notions of microbial infection. Group membership also influences the
emergence of social responses to infectious diseases, such as the kind of com-
munity organizing that has emerged worldwide around HIV disease.

Using Theory

This discussion underlines the importance of theory in the anthropology of

infectious disease. Medical anthropologists concerned with health issues have
utilized and combined various theoretical perspectives in their work. Medical
ecological theory stresses the ways societies respond to the challenges and op-
portunities presented by the physical environments and climatic conditions they
face, including the local presence of particular infectious agents. Within this
theoretical framework the health of a population is seen as a complex reflection
of the group’s degree of success in meeting these challenges, including those
generated in the social environment.
Exemplary is anthropologist Edward Green’s (1999) argument that indig-
enous beliefs about disease contagion around the world are not necessarily the
result of the influence of biomedicine but often are rooted in far older cultural
ideas about body pollution. Such beliefs, he suggests, are adaptive in that they
lead to behaviors that reduce the spread of infectious diseases. If a man, for ex-
ample, avoids having sexual intercourse with many partners or with commercial
18 ❋ in t ro duc t io n

sex workers to protect himself from uncleanliness and mystical pollution, he

reduces his exposure to pathogenically transmitted diseases associated with
sexual intercourse even if he is unaware of bacteria or viruses. In other words, in
the course of human history beliefs about pollution-based contagion developed,
and these had adaptive value in lowering rates of infection and were retained in
various cultural systems up to the present. Moreover, indigenous ethnomedical
systems are not, as some might see them, “superstition, meaningless pseudo-
psychological mumbo-jumbo, which is positively harmful” to health (Nthato
Motlana quoted in Freeman and Motsei 1992:186); rather, although containing
some practices that may be harmful, on the whole they are historic adaptive
systems that have contributed to human survival in varied environments.
Phenomenological and related meaning-centered approaches draw attention
to the subjectivities of illness and the ways it is experienced, interpreted, and
made meaningful in human societies. For example, in her research in Indonesia,
anthropologist Karen Kroeger (2008:343) found AIDS rumors shared among
people “are a kind of ‘somatization’ of pathology in the Indonesian body politic,
a metaphorical expression of concerns that Indonesians have about the break-
down of the social order and the power of the Indonesian state.” Participation in
spreading AIDS rumors—such as tales of unknown assailants sticking people
with infected syringes—involves drawing on existing cultural symbolism in
Indonesia in the midst of an epidemic to express growing social (dis)ease and
a sense of vulnerability in a tense and conflicted society.
A final theoretical perspective, discussed more fully in Chapter 7, is known
as critical medical anthropology. This framework, which is conceptually linked to
ecosocial theory in epidemiology, views health as an expression of social relations
within society, especially the ways that social inequality structures health disparities
and vulnerability, patterns morbidity and mortality, and contributes to the social
distribution of disease-related social suffering but also to health-related resilience,
agency, and social action. Commonly social relations in society are mediated by
environmental conditions, including anthropogenic impacts on the environment,
such as the contributions of greenhouse gas emissions to global warming and,
consequently, to warming-related dissemination of infectious diseases. Critical
medical anthropology seeks to focus attention on the complex of interactions
between the local and the global, the sociocultural and the biological, the human
and nonhuman environments, and the rich and poor in infectious diseases. From
the perspective of critical medical anthropology, we cannot understand the global
pandemic of HIV disease independent of the international, national, regional, and
local structures of unequal social relationships, and processes of social challenge
and conflict have helped to determine who gets infected, under what conditions as
well as what is their access to treatment and the consequences of infection.
 anthropology and the large impact of small worlds ❋ 19

The first chapter of this book lays a foundation for the anthropology of
infectious diseases, presenting some key lessons of biocultural and biosocial un-
derstanding as well as core concepts and special attributes anthropology brings
to comprehending disease in human societies. Chapter 2 focuses on microbes as
entities in the world. The chapter emphasizes the unexpected complexity of these
organisms; their origins, variety, considerable impact on the world around them,
their social interactions with each other; and both beneficial and malevolent
interactions with humans. Chapter 3 delves more deeply into the implications
of the fact that our species does not live separately from other species and their
infectious diseases. It reports current knowledge on the development of both
HIV and Lyme disease as examples of the biosocial nature of infectious diseases.
The role of the environment and dramatic human impacts on the environ-
ment in the nature and spread of infectious disease is addressed in Chapter 4.
This discussion extends a central theme of the book: the complexities of our
entwinement with the world around us and the ways our actions rebound on
our health. Chapter 5 highlights critical changes in today’s world of infectious
agents and disease, including the emergence, reemergence, and drug resistance
of pathogens as well as health implications for humans. The following chap-
ter concentrates on infectious disease syndemics and the social conditions
that foster pathogen concentration and adverse interaction. The last chapter
explores the multiple ways imbalances of power produce savage inequalities
in the distribution and health consequence of infectious diseases. A primary
message of the chapter is that you cannot understand infectious disease in the
world independent of the way social structures produce significant disparities
in living conditions and other aspects of daily existence. Together the chapters
in this book show the benefits of turning the anthropological lens on infectious
diseases, revealing clearly the biosocial and biocultural nature of these condi-
tions that significantly impact all life on Earth.
20

Chapter one

Defining the Anthropology of Infectious Disease

Toward a Biocultural/Biosocial Understanding

I believe that there is no dichotomy between the natural world and the
human environment
Juliet Clutton-Brock (1994:23)

Humans and Pathogens

The human species evolved in a world already populated by pathogens. Surviving

bone material of our distant hominid ancestors dating to over a million years
ago shows evidence of infectious diseases. Our attempts to understand infec-
tion and the human relationship with infectious disease systematically is far
younger. Younger still is anthropological work on the topic, which dates only to
the mid-twentieth century. In this short time, however, we have learned some
key lessons about the biocultural and biosocial nature of infectious disease. This
chapter explores these lessons as well as core concepts in the anthropology of
infection, the special contributions of anthropology to our understanding of
infectious diseases, and the biosocial/biocultural and political ecological vision
the discipline brings to this domain of research and practice. It underlines the
importance of understanding infectious disease as a multistranded intersection
of biology—both our own and that of pathogens—and human social and cul-
tural systems in a globalizing and environmentally disrupted world. The chapter
then identifies some of the research methods anthropology brings to the study of
infectious diseases and concludes with several questions for further discussion.

Developing an Anthropology
of Infectious Disease

Most anthropological research on infectious disease occurs within the subfield

of medical anthropology, a domain concerned with health in social and cultural
context. Marcia Inhorn and Peter Brown, whose volume The Anthropology of
Infectious Disease was a benchmark for the new field, define it as “the broad
area which emphasizes the interaction between sociocultural, biological, and

Anthropology of Infectious Disease, by Merrill Singer, 20–59. © 2015 Left Coast Press, Inc. All rights reserved.
 defining the anthropology of infectious disease ❋ 21

ecological variables relating to the etiology and prevalence of infectious disease”

(1990:91). This definition can usefully be broadened to read: the anthropology
of infectious disease is the arena of applied and basic anthropological research that
focuses on the interaction among sociocultural, biological, political, economic, and
ecological variables involved in the etiology, prevalence, experience, impact, cultural
understanding, prevention, and treatment of infectious diseases.
The first focused anthropological work on infectious disease began in the
post–World War II period of the 1950s, in a new era characterized by interna-
tional development aimed to assist less developed countries achieve Western/
Japanese levels of technological and civic development. Although Western
countries framed these initiatives in humanitarian terms, they had other mo-
tives as well. As a result of the war and the national liberation movements that
arose after movement in succeeding decades, many former colonies, for example
in Africa and Southeast Asia, gained independence. The coalition between the
United States, Europe, and the Soviet Union, tenuously held together in opposi-
tion to Germany and the Axis powers during World War II, quickly dissolved
into Cold War rivalries. The postwar passion for international development was
strongly driven by worry in the West that underdeveloped nations would turn
to communism rather than capitalism. Although then billed as a humanitarian
effort the huge mobilization for development had a definite political subtext.
What is commonly referred to as the Western model has guided develop-
ment initiatives of the United States and Europe. This model was a “top-down”
approach to development that reflected the goals and values of the industrial-
ized nations. One of its tenets was the “conviction that enhanced economic
growth automatically brings with it increased prosperity and a better way of
life for all—not only the already affluent but, in the long run, the disadvantaged
members of society as well” (Millen, Irwin, and Kim 2000:6). This belief, which
reflects Western cultural ideals, was hardly questioned at the time; indeed, the
array of cultural patterns in countries targeted for development was seen as an
obstacle to acceptance of the Western model. In this context, the idea emerged
among international development professionals that anthropological research
on cultural patterns and on planned cultural change could be useful in imple-
menting development programs.
Practitioners of development working within the Western model sought
to eliminate all barriers to economic expansion, and disease and unsanitary
conditions were quickly identified as significant obstacles. Thus, part and parcel
of the Western model was the idea that biomedicine, the Western approach to
addressing health issues, was a critical component of the normal development
process. Biomedicine, now a globally dominant medical system, is based on
natural-science principles. Its particular understandings of human anatomy and
22 ❋ ch a p t er o ne

the causes and clinical treatment of diseases are institutionalized around hospi-
tal-based or -linked treatment, a hierarchy of specialized clinical practitioners,
and, with reference to infectious diseases, a supportive set of ideas and actions
regarding identification of pathogens, hygiene, sanitation, and pharmaceutical
intervention. It is widely held that biomedicine is universal and acultural, in
contrast to ethnomedicine, for example, which implies that a medical system is
embedded within a specific cultural tradition.
In recent decades anthropologists have been critical of the distinction,
highlighting the sociocultural nature of biomedicine and viewing it as a Western
ethnomedical tradition that gained worldwide distribution through its historic
connections to colonialism and corporate globalization. But in the post–World
War II period anthropologists were invited to engage in new development-
driven health promotion programs that implemented centralized biomedical
treatment in urban areas. In short, anthropologists’ first involvement with
infectious disease work supported Western-oriented development in roles
that the discipline itself later criticized as being subordinated handmaidens of
biomedicine (Browner 1999).
Anthropologists in the postwar period found, in fact, that attempts to export
biomedical ideas often did not work as planned. One example is the experience
of Edward Wellin, who was sent to southern Peru in the early 1950s as a gradu-
ate student through a Rockefeller Foundation program on health promotion.
He observed an effort designed to get people to boil drinking water to avoid
infection. Wellin wrote about two of the Peruvians he worked with in the town
of Los Molinos:

Although Mrs. F and her daughter have attended several . . . [hygiene pro-
motion] talks, they remain unreceptive to the notion of bacteriological
contamination and unconvinced of the need to boil their drinking water.
. . . How, she argues, can microbes fall into water? Are they fish? If they
are so small that they cannot be seen or felt, how can such delicate things
survive in water? Even in the clean water they would have no chance, let
alone in dirty water. . . . There are enough real threats in the world to worry
about—“cold” [as in hot/cold imbalance], [bad] “airs”, poverty and hun-
ger—without bothering oneself about animals one cannot see hear, touch
or smell. (1955:92)

After two years of water-boiling promotion efforts to reduce water-borne

infections, only eleven housewives were convinced to boil water. Benjamin Paul
effectively articulated anthropology’s key insight into this kind of biocultural
encounter with infectious disease:
 defining the anthropology of infectious disease ❋ 23

If you wish to help a community improve its health, you must learn to think
like the people of that community. Before asking a group of people to as-
sume new health habits, it is wise to ascertain the existing habits, how these
habits are linked to one another, what functions they perform [for society],
and what they mean to those who practice them. (1955:1)

Although anthropologists today might wince at the phrase “learn to think

like the people,” Paul’s emphasis on seeking to understand the emic—or in-
sider’s—perspective remains a core lesson. But the question of exactly what
role anthropologists should play in health development remains controversial.
The World Health Organization (WHO) arose as a leading player in health
development during a period (1950s–1980s) now known as the Era of Interna-
tional Health. During these decades campaigns to improve world health were
largely dominated by biomedicine and, except for water and sanitation projects,
focused on narrowly defined programs and individual patients rather than on
broader social and economic issues in underdeveloped nations, including issues
of poverty; unequal access to basic resources; discrimination based on class,
ethnicity and gender; and, ultimately, the structure of unequal relations between
wealthy and poor nations.
During the 1970s, the World Health Organization created the Tropical
Disease Research program (TDR), which further opened the door for a num-
ber of anthropologists to become involved in infectious disease research. It
was during this period that infectious disease research finally “won its spurs”
as a legitimate topic for anthropology. In subsequent years the TDR adopted
an aggressive emphasis on addressing the infectious diseases of the poor and
disadvantaged, harmonizing with anthropology’s biocultural view of health
and the inseparability of disease and society.
For a brief period following the signing of the 1978 Alma Ata Declaration by
WHO member nations, international health advocates rallied around the recog-
nition that health should be addressed as a fundamental human right. They paid
particular attention to the social origins of disease and the implementation of
horizontal (participatory) rather than vertical (top-down) programming. These
ideas, embraced by many medical anthropologists, were a direct challenge to
the status quo and biomedical reductionism. Unfortunately the “health-for-all
initiative,” as it came to be known, was undermined at every turn, and by the
1980s the World Health Organization had returned to its former strategy of
focusing on primary health care with narrowly targeted interventions.
In the midst of these struggles, anthropologists strengthened their own
biocultural approaches and professional networks. In 1980, just before the
dawn of the HIV disease era, a group of anthropologists working on infectious
24 ❋ ch a p t er o ne

disease formed the Working Group on Anthropology and Infectious Disease;

subsequently the International Health and Infectious Disease Study Group
and the AIDS and Anthropology Research Group were created. Although
only the latter group survives within the Society for Medical Anthropology,
anthropological involvement in infectious disease research and the application
of research to health improvement continues to grow unabated. Today there
are anthropologists working on infectious disease issues all around the world.
The post–World War II rise of international development was an endeavor
so massive that it is frequently referred to as the “development-industrial com-
plex” and has had a major role in shaping the twentieth-century world order.
Beyond its involvement in international development issues, the anthropology
of infectious disease has been influenced by a number of other factors, academic,
socioeconomic, and political in nature. A review of six of these additional influ-
encing factors that have played a role in the emergence of the anthropology of
infectious diseases follows below. This mosaic of influences laid the foundation
for a major subfield of research and application that lies on the cusp between
biological and cultural anthropology.

Paleopathology

Paleopathlogy is the study of the diseases suffered by people who lived in the
past as revealed through archeological excavation. The term unites “paleo,”
meaning ancient, with pathology, which is the study of disease processes. Marc
Armand Ruffer, who named the field, often is credited with being the first pa-
leopathologist based on his discovery and description of the parasitic disease
urinary schistosomiasis among Egyptian mummies, which he published early
in the twentieth century. After the Second World War concern about the role of
disease in shaping ancient societies grew significantly within archaeology, the
branch of anthropology that deals with understanding past societies and their
change over time and across geographical contexts. Human remains, primarily
skeletal materials, record the impact of various diseases and provide clues to the
health challenges of prehistory. In addition, ancient DNA of infectious agents
can be recovered from human remains that are hundreds of years old.
By examining the skeletal remains of populations that lived in different
environments, paleopathology researchers have been able to gain new insights
concerning the long-term interrelationships among human biology, cultural prac-
tices, and infectious diseases. For example, paleopathology has helped to reveal
changes in patterns of infectious diseases in human populations that accompanied
the transition from hunting and gathering to agriculture. In this transition people
became more sedentary, increasing the likelihood of infectious disease exposure,
 defining the anthropology of infectious disease ❋ 25

and they began to spend more time around domesticated animals, creating op-
portunities for pathogens to move from animals to people. Signs of infection in
human remains increased as settlements grew in size and became more permanent.
Mycobacterial diseases that have been a factor in human history for mil-
lennia have particular interest for paleopathologists “because they afford op-
portunity to examine the interactions between an infectious agent and human
migration and settlement patterns” as well as between diet and infectious disease
(Wilbur et al. 2008:963). For example, paleopathologists have contributed im-
portant research to our biocultural understanding of tuberculosis and leprosy.
In the case of tuberculosis, bone and joint changes can occur, usually in adult-
hood, three to five years after infection. In excavated skeletons tuberculosis
commonly is identified by the presence of lesions, often in the vertebrae of the
spine, although other skeletal indications, like pitting and new bone formation
on rib surfaces, have also been linked to tuberculosis. Additionally, ancient
DNA of the bacterial agent that is the immediate cause of tuberculosis has been
recovered in archeological finds (Murphy et al. 2009). Although there was a
long dispute about whether tuberculosis was only introduced to the New World
with the arrival of Europeans, recent research has documented tuberculosis in
skeletons from Point Hope in Alaska that date as far back as over two thousand
years ago (Dabbs 2009).
Paleopathology investigation of the skeletons excavated at Naestved, the
site of a medieval leprosy hospital in Denmark (Møller-Christensen 1978),
found that most of the individuals exhibited cribra orbitalia—small holes in the
bone ridges under the eyebrows caused by the body’s effort to produce more
red blood cells in bone marrow nourished by an iron-deficient diet. This find-
ing is interpreted as evidence that people who were most susceptible to leprosy
were the poor. As Manchester observes, “The possibility of chronic intestinal
parasitic infestation in infancy contributing to this anemia may also suggest a
poor general health status and level of poverty” (1991:28). This research sup-
ports recognition that leprosy is most commonly a disease of poverty, associ-
ated with overcrowding—as the pathogen is transmitted through breathing in
the exhalation of an infected individual—and socially compromised immune
systems. This kind of work on the diseases of ancient societies adds historical
depth to the anthropological understanding of the intersection of infections
and human societies through time and place.

Children’s Survival Initiative

In the 1980s, in the wake of the International Year of the Child, UNICEF
launched the Child Survival Initiative. Initially its efforts focused on oral
26 ❋ ch a p t er o ne

rehydration for diarrhea disease, which usually has an infectious proximal

origin, and on immunization against common infectious agents. Numerous
anthropologists worked on these programs and became knowledgeable about
infectious diseases. An early document that came out of this initiative empha-
sized the fact that “more than 40,000 young children have died from malnutri-
tion and infection. And for everyone who has died, six now live on in . . . hunger
and ill-health which will be forever etched upon their lives” (Grant 1982:4). It
proceeded to make the case for a global push for socially appropriate programs
to promote child survival. Recognition of the importance of malnutrition in the
spread of infection, which draws attention to issues of poverty, access to food,
and the causes of food insecurity, further affirmed a biosocial perspective in
addressing infectious diseases.
Malaria has long been a major cause of child death in affected areas. In
response, through the Children’s Survival Initiative, anthropological con-
sultation was solicited to ensure that prevention efforts would be effective in
light of local cultural beliefs and behaviors. In Gambia, for example, where
insecticide-treated bed nets were being distributed, anthropologists provided
program managers with ethnographic information on family sleeping patterns,
attitudes, and preferences regarding net use, strategies for protecting children in
the poorest households, and ways to train local health educators. Anthropolo-
gists provided additional input on the design of health education approaches
that build on indigenous conceptions and how to most effectively distribute
preventive chloroquine tablets through existing village organizational struc-
tures, including how to best involve people from the most socially marginal
households. During this process an anthropologist first systematically docu-
mented perceived side-effects of taking chloroquine reported by community
members (MacCormack 1985).

HIV Disease

When the HIV disease pandemic emerged, the disease was expressed differ-
ently across countries and groups, and “risk behaviors” were poorly understood.
This created a demand for anthropological research domestically and interna-
tionally, drawing hundreds of anthropologists over the years into the study of
infectious disease. Individuals whose first involvement in infectious disease
research was work on HIV disease went on to investigate a range of other infec-
tious diseases, a domain further broadened by the students of these research-
ers. To the study of HIV disease, anthropologists, as indicated in numerous
studies discussed in this book, brought a focus on comprehending both local
and wider social and cultural contexts that facilitate disease transmission, an
 defining the anthropology of infectious disease ❋ 27

emphasis on accessing community knowledge about and emotional responses

to the epidemic, and a recognition that structures of inequality in society tend
to be replicated through identifiable pathways in patterns of disease transmis-
sion and course.
Exemplifying the kinds of work anthropologists have done on HIV dis-
ease, in 2003 anthropologists affiliated with the Hispanic Health Council, a
community-based service and research institute in Hartford, Connecticut, were
funded by the federal Office of AIDS Policy to implement a rapid ethnographic
assessment of factors contributing to the epidemic that existing prevention
programs were not addressing (Singer and Eiserman 2007). Discussions with
community representatives and members of the research team led to a decision
to examine late-night risk in the city, as there were no prevention efforts going
on after city health offices and community organizations closed for the evening.
As part of the project team’s data-collection strategy, interviewers were sent to
sites around the city where high-risk behaviors (e.g., drug use, commercial sex
transactions) had been observed in prior research. Team members approached
people on the street and asked them whether they would be willing to participate
in a brief interview that addressed (1) a participant’s major sociodemographic
characteristics (e.g., age, gender, employment status), (2) knowledge about
places around town where high-risk behaviors occur, (3) knowledge about
groups of people who could be found on the street during late-night hours, (4)
types of late-night risk behaviors that occurred locally, (5) the participant’s
degree of exposure to HIV prevention materials, and (6) perception of HIV-
related needs in Hartford. In total sixty-seven short walk-up interviews were
completed. These were followed by in-depth interviews with individuals who
fell into one of four groups engaged in risk behaviors: drug users, drug sellers,
commercial sex workers, and men who have unprotected sex with other men.
The field team conducted thirty-one in-depth interviews. Based on the data col-
lected from these approaches, the project concluded that people who are active
on the street during late-night hours tend to engage in more risk behavior (e.g.,
sex without a condom, injection drug use, commercial sex) than people who can
be contacted on the street during the day. The study also found that people who
sleep during the day but are active on the street at night have less contact with
HIV prevention services than their counterparts who are active during the day.
Consequently the researchers urged the city of Hartford to support late-night
prevention efforts (e.g., education and condom distribution) targeted at specific
“hot spots” around the city where there was a concentration of after-hours risk
behavior. The city responded favorably to this recommendation, and funds were
directed toward the implementation of late-night street efforts intended to stem
the spread of HIV disease.
28 ❋ ch a p t er o ne

New and Reemerging Diseases

Today previously controlled diseases are reemerging, in part because of HIV-

involved syndemics, and there is growing awareness of new, emergent infectious
diseases such avian flu, swine flu, and SARS. In 1989 a conference on viruses,
sponsored by Rockefeller University, the National Institute of Allergy and
Infectious Diseases, and the Fogarty International Center, sparked interest in
the emergence and resurgence of all classes of pathogens. It brought together
researchers who shared a growing concern regarding a perceived “complacency
in the scientific and medical communities, the public, and the political leadership
of the United States toward the danger of emerging infectious diseases and the
potential for devastating epidemics” (Lederberg, Shope, and Oaks 1992:vi). New
attention focused on the concept of “emerging infectious diseases,” a term that
developed within biomedicine and diffused from medical circles into general
scientific discourse and from there to the lexicon of the mass media during the
1990s (Washer 2010). This created the conceptual space for a multidisciplinary
array of approaches to infectious disease, including those formulated within
anthropology. This opening was facilitated by recognition that biology alone
could not account for the changing world of infectious diseases and human
behaviors, such as the cutting down of forests, the overuse of antibiotics, and
the human-generated changes in climate, all of which were playing fundamental
roles in new and renewed infectious disease epidemics.

Global Warming

Anthropological attention to human engagement with the environment has a

deep history within the discipline. During the 1950s, with the insightful contri-
butions of Julian Steward (1955), a new ecologically informed perspective began
to emerge in anthropology. In this new approach to the human relationship to
the rest of nature, a heightened awareness of the widespread impact of human
activities on the world replaced an older environmental determinism perspec-
tive. More recently, in what has come to be called environmental anthropology,
an applied “study of the human-environmental relationship [has been] driven
largely by environmental concern” about climate change, natural disasters, loss
of biological diversity, the spread of infectious diseases, and related issues of
sustainability (Shoreman-Ouimet and Kopnina 2011:1). It is becoming clear that
climate change is having serious political-economic, sociocultural, and health
impacts on societies that have never before in human history faced an environ-
mental threat on this scale and complexity in such a compressed time frame.
Belatedly, researchers have awakened to the role of global warming in the spread
 defining the anthropology of infectious disease ❋ 29

of infectious diseases through the movement of water-borne, vector-borne, and

wind-blown pathogens. Singer (2013b), for example, examines various physical
interactions between global warming and air pollution in the exacerbation and
increasing frequency of global respiratory diseases such as asthma. Similarly
Armelagos and Harper (2010:303) observe that various infectious vector-borne
diseases, such as dengue and chikungunya, are on the rise in part due to global
warming. Anthropology thus far has contributed only a limited amount of work
on this topic, but given the grave risk involved and the discipline’s strength in
developing biocultural understandings of ecology, culture, and health, global
warming is another impetus for anthropological work on infectious disease
(Baer and Singer 2009, 2014).

Global Health

During the 1990s the leading paradigm in health development shifted from
“international health” to “global health.” The rise of the concept of global health
paralleled the rise of the new economic term “global economy,” which recognized
the advancing and systemic economic globalization of human communities on
our planet. The global health concept also reflected a shift in perspective from
a focus on health issues within nations and regions to the understanding that
factors that affect health transcend national borders and are deeply entwined
with issues of socioeconomic class, ethnicity, gender, and culture. To put this
another way, the shift involved recognition of the fundamental importance to
health of flows of capital, people, infectious agents and diseases, medicines,
commodities, ideas, and practices that move relatively readily across our cultur-
ally constructed political boundaries and that differentially affect the health of
everyone. This notion coincides with anthropological attention to global flows
in other subfields of the discipline (Appadurai 1990).
As a result of the various influences discussed above, in increasing numbers
medical anthropologists are working on infectious disease issues in various roles
within the World Health Organization, the Centers for Disease Control, other
government bodies, domestic and international nongovernment organizations
(NGOs), and in other scholarly and applied venues. In addition, an impressive
body of literature in the field has developed (e.g., Hesser 1982; Inhorn and Buss
2010; Larsen and Milner 1994; Manderson 2012; Mascie-Taylor 1993). In some
ways, however, the anthropology of infectious disease remains an emergent
arena of research and applied work because it has yet to consolidate into a sub-
field with established concepts, theoretical frameworks, conferences, journals,
and a distinct identity among participants or to have acquired other common
markers of disciplinary institutionalization. The field is somewhat scattered and
30 ❋ ch a p t er o ne

lacks an organizational core, although the contributions of the anthropological

approach are known to varying degrees in other health-related disciplines. Still,
as Barry and Bonnie Hewlett (2008) observe with reference to their work on
ebola, initially it never occurred to anyone combating the disease at the World
Health Organization to involve anthropologists; it was only through their own
initiative that anthropologists gained a useful role in research and prevention
efforts with this deadly infectious disease. This is because, despite important
conceptual developments discussed in this section, biomedicine remains the
dominant tendency in global health work on infectious disease, with only sec-
ondary consideration given to the fact that these diseases are shaped by and, in
turn, shape the societies and cultural systems in which they are found.
Challenges to the traditional approach have grown in recent years as rec-
ognition that infectious disease is not simply a consequence of the presence of
pathogens or even the interaction of pathogens and the human immune system.
Microbes in the environment become the immediate source of human infectious
diseases and have shifting distributions and changing levels of virulence because
of human activities, social structures, and cultural configurations. So too the
way communities respond to the presence of infection, including behaviors
that promote and limit the spread of disease, the manner in which others treat
infected individuals, and campaigns to control or eliminate infectious agents
are all social and not narrowly biological in nature. These factors open doorways
for the further development and expanded contributions of the anthropology
of infectious diseases.
This book invites you to explore questions that remain somewhat open:
What is the anthropology of infectious disease, and what does this field offer
to the broader human engagement with communicable disease?

Key Concepts in the Anthropology

of Infectious Disease

Within anthropology in recent years there has been a fundamental shift in

perspective that has been labeled the biocultural synthesis. A paper authored
by George Armelagos and colleagues (1992) signaled the need for this develop-
ment. The paper was written in response to recognition that the field of medical
anthropology at the time was bifurcated into cultural and biological wings, with
limited communication across these dominant orientations. Those who came
to the study of health with a cultural focus tended to emphasize ethnomedical
research that examined cultural patterns of defining disease and described local
social responses to it. Those with a biological orientation paid closest attention
to the interactions of a population, identifiable disruptions of bodily organs and
 defining the anthropology of infectious disease ❋ 31

process, and the environment factors at the core of the disease process. The lack
of a biocultural integration, these authors lamented, was hindering the system-
atic analysis of health and disease across societies. Building on an idea originally
proposed by the biological anthropologist Paul Baker, they urged adoption of an
ecological model informed by an integrated biocultural understanding of the
disease process to addresses this problem. This approach led to the publication
of the paradigm-framing volume Building A New Biocultural Synthesis (Good
and Leatherman 1998), which brought together the work of biological, cultural,
and archeological anthropologists. It also contributed to the development of a
number of university medical anthropology training programs that emphasize a
biocultural approach to health issues, such as Emory University, the University
of Alabama, University of Washington, the University of Connecticut, and the
University of Massachusetts, Amherst.
Within this context, central to the emergent field of the anthropology of
infectious disease is a biocultural or biosocial conceptualization. This is the
understanding that both cultural and social factors in environmental context
significantly mediate the impact of infectious agents on humans. Although the
dominant approach to health in society is biomedical—and involves a con-
ceptualization that attempts to isolate and identify biological causation—the
anthropological biocultural or biosocial approach is instead integrative, insisting
that biological life simply does not exist in isolation from social and cultural life.
The starting point for a biocultural/biosocial conceptualization of infec-
tious disease is recognition that infection is always more than just biology in that
it is a product of interaction on various levels. One of these levels, assuredly,
is biological. Infectious agents, be they viruses, bacteria, protozoa, helminths,
fungus, or other pathogens, are necessary for infectious disease to occur. So too
are the bodies of the hosts they infect, including their immune systems, which
have evolved over millions of years as biomechanisms for limiting the harm done
by pathogens. Although pathogens are necessary for infection, their presence is
not sufficient to explain how and why infection occurs at particular times and
places and with particular outcomes. To address these issues we must consider
cultural and social factors, often as mediated by environmental conditions. As
Niewöhner (2011:289–290) writes, the human body is “heavily impregnated
by its own past and by the social and material environment within which it
dwells. It is a body that is imprinted by evolutionary and transgenerational time,
by ‘early-life,’ and a body that is highly susceptible to changes in its social and
material environment.”
Although many anthropologists blend the cultural and social aspects of
human life, using terms like “sociocultural processes,” there is heuristic value in
maintaining conceptual differentiation. The term cultural factors, as used in this
32 ❋ ch a p t er o ne

book, refers to the beliefs, meanings, norms, values, and stylistics of local behav-
ior that give a distinctive pattern to the various human lifeways. Interpretations
of HIV disease as evidence of witchcraft or punishment from God, which are
specific local understandings of the nature and causes of this infectious disease,
are examples of cultural conceptualizations. So too is the traditional folk belief in
Sweden that cholera was spread by an agent of the king to limit the populations
of the poor or the Haitian belief during the contemporary cholera epidemic that
the disease was introduced by nongovernment organizations as a way to raise
money. Many cultural beliefs—such as what is edible or desirable to eat, what
a dwelling structure should look like and be made of, whose responsibility it is
to acquire water—can shape exposure to agents of infectious disease.
It is also analytically valuable to distinguish the social origins and outcomes
of infectious disease. In this case we are concerned with questions such as: Why
do infectious diseases tend to cluster among the poor? How do social structures,
like the global operations of transnational corporations, promote the spread of
diseases? How does war spread infectious disease? These are questions about the
biosocial nature of infectious diseases. Social systems can incorporate peoples with
diverse cultures. In the contemporary world, the Ju/’hosani—indigenous people
of southern Africa who have a tradition of living by hunting and gathering—sheep
herders on the grasslands of the Tibetan Plateau, mine workers in Bolivia, and the
readers of this book may have quite different cultures, but all are significantly af-
fected by their incorporation within the global capitalist economy, which is a social
structure. This book is concerned with both biocultural and biosocial interactions;
it recognizes that cultural and social processes and structures are entwined in the
real world but that it is useful to separate them for heuristic purposes.
What do biocultural and biosocial understandings of an infectious disease
actually look like? Tuberculosis provides an example. It is known to be linked
to the bacteria Mycobacterium tuberculosis. Yet the presence of these bacteria
alone does not explain why only 25 to 50 percent of people exposed to it become
infected or why only 10 percent of those who are infected develop full-blown tu-
berculosis, with adverse consequences if untreated (Dutt and Stead 1999). Based
on a review of the literature, Ming-Jung Ho (2004), a cultural anthropologist,
has identified key cultural and social factors that help explain these patterns as
well as the fact that tuberculosis is disproportionately common among disad-
vantaged populations and has had a resurgence in developed countries since the
late 1970s. For example, communal water-pipe smoking, a custom practiced in
a number of African and Asian countries that also has defused to the West, is
now recognized as a cultural practice that promotes the spread of tuberculosis
(Knishkowy 2005). According to Rania Siam, professor of microbiology at the
American University in Cairo,
 defining the anthropology of infectious disease ❋ 33

“Shisha” [smoking] is Egyptian culture, where people smoke tobacco and

inhale directly from this device. If I smoke “shisha”, some bacteria may re-
side in it. When you go to a fancy bar, they do change the mouthpiece, but
what about the tube of the pipe? And the water? You still have water in the
container where the bacteria resides. (quoted in Fuchs 2008)

Communal water-pipe use could potentially transmit numerous other

pathogens, including hepatitis C, herpes simplex, Epstein-Barr virus, and vari-
ous respiratory viruses (Knishkowy 2005). Another cultural factor identified
in Pakistan, the folk belief that tuberculosis medicines are ineffective during
pregnancy (Nichter 2008), could contribute to treatment cessation and disease
progression among pregnant women.
In an important set of studies William Dressler and coworkers (e.g., Dressler
and Bindon 2000, Bindon 2007) have developed the concept of cultural conso-
nance as a tool for assessing the degree to which individuals in their daily lives
are able to conform to locally defined cultural models for a “successful lifestyle”
and the health consequences (e.g., experience of stress and elevated blood pres-
sure) of lack of consonance. Building on this idea, McDade (2002) developed
a biocultural analysis of societal change, stress, and infectious disease among
adolescents in Samoa. Traditionally Samoa youth were taught to be highly
respectful of elders and strongly family oriented; they recognized that one’s
personal status was closely linked to one’s position in their extended family and
the position of their family in the community. Customary status determinants,
however, have been rocked by the introduction of Western lifestyles, ideas,
commodities, education, wage labor, universal suffrage, migration off-island for
jobs and the sending of monetary remittance to one’s family, and other dramatic
changes. One consequence is what McDade calls status incongruity, a tension
between the social status an individual holds using the traditional cultural
model versus the social status they acquire as a result of their involvement in
introduced Western cultural patterns. He found that youth in Samoa often feel
caught between conflicting social pressures to adhere to both traditional and
emergent cultural systems, and he linked this incongruity to both rising ado-
lescent suicide rates and the uncertainty and confusion adolescent participants
often express in social science research. McDade used a combination of semi-
structured interviews, psychosocial information, and blood samples to assess
immune function. He tested for the presence of antibodies against Epstein-Barr
virus (EBV); immunological response to this herpes virus has been shown to be
a consistent immunological marker of chronic stress. In other words, individuals
infected with EBV harbor the virus for the rest of their lives, but it is typically
kept in a latent state by cell-mediated immune function. Stress, however, can
34 ❋ ch a p t er o ne

compromise this immune function and allow EBV to switch to an active state,
in which it releases viral antigens that can trigger a humoral antibody response.
Consequently EBV antibody level is defined as a biomarker of psychosocial
stress (a higher level of antibodies indicates lower immunity). McDade found a
significant association between elevated antibody levels and status incongruity
in adolescents, suggesting reduced cell-mediated immune function and a higher
burden of psychosocial stress. Thus, this study revealed how social and cultural
changes that produce stressful life experiences are linked to the transition from
latent to active infections, further revealing a fundamental aspect of biocultural/
biosocial interaction in the making of infectious disease.
Some cultural patterns, by contrast, may inhibit disease transmission.
In his research, Norbert Vecchiato (1997) found that the Sidama of Ethiopia
believed that overwork, excessive exposure to the sun, or carrying heavy loads
could cause tuberculosis (locally known as balamo). They also believed that
“avoiding contact with a patient” was the best prophylactic measure against
contracting this disease. It also has been found that certain cultural practices
may affect wealthy and poor sectors of a hierarchical society differently. Brown
(1998), for example, describes how the traditional social organization of the
grape harvest in Bosa, Sardinia, an autonomous region of the Italian Republic,
provided protection to the social elites from malaria. During the malaria season
the land-owning families of Bosa moved to summer homes on high ground so
they could supervise the harvest. The working class, however, remained living
in lower areas where infected mosquitoes were most numerous.
Social factors, including issues of social hierarchy and inequality, the ex-
ercise of power, and diverse forms of abuse are absolutely critical to the spread
and impact of infectious diseases. Chagas disease is a vector-borne infection
transmitted by triatomins (kissing bugs) that can produce initial symptoms like
fever, fatigue, body aches, rash, and nausea and may lead to more severe out-
comes, including congestive heart failure and cardiac arrest. It is most rampant
among the poor and happens to be one of the most neglected diseases interna-
tionally: “its unequal distribution illustrates the complex interaction of socio-
cultural, biological and environmental factors” (Ventura-Garcia et al. 2013).
For example, during the 1980s in the Amazon region, governments supported
economic policies that enhanced industrial production, international trade, and
globalization; promoted road building, land expropriations, and deforestation
(to support pasturing and beef exploration); forced migration of families to
cities; and expanded poorly remunerated wage labor. These changes “altered
the traditional conditions that had controlled transmission of the infection
to humans” (Briceño-León 2007:36). Triatomins, previously located in more
 defining the anthropology of infectious disease ❋ 35

wooded areas, began occupying domestic spaces, and household infestation

increased, an incursion facilitated by crowded and impoverished living condi-
tions and shoddy housing construction characterized by cracks and crevices in
walls and roofs where tiatomines could find shelter (Coimbra 1988). In short,
social factors significantly changed the domain of Chagas disease, resulting in
spiraling rates of infection.
But cultural and social factors do not just influence what pathogens can
do; biocultural/biosocial approaches show us that cultural and social processes
affect what pathogens actually are. Pathogens constantly evolve in response to
changes in the conditions of hosts, such as the development and use of antibiot-
ics, shifting dietary practices, alterations in lifestyle, and so on. The reverse is
also true: the presence of infectious diseases shape cultural and social systems.
For example, in Armies of Pestilence: The Impact of Disease on History, R. S. Bray
(2004) reviews the multiple ways diseases such as plague, cholera, smallpox,
typhus, yellow fever, influenza, and AIDS have affected the course of history,
the configuration of human beliefs and behaviors, and the organization of social
systems.
One of the primary ways medical anthropologists think about the actions and
effects of infectious diseases is in terms of the environment. This line of thinking,
more broadly known as the EcoHealth perspective, is concerned with how changes
in human ecology, including both naturally occurring and human-promoted
changes in Earth’s ecosystems, affect human health. For example, emissions from
factories, vehicles, and other technologies that burn fossil fuels wind up as large
quantities of carbon dioxide in the oceans. Heavy dosing of agricultural areas
with fertilizers has led to the run-off of potent chemicals, including nitrates and
phosphates, into the oceans. Atmospheric CO2, also from emissions, in turn, is
contributing to heating up the oceans. One result of all of these changes in the
composition and temperature of ocean waters is the presence along US coasts
of harmful red tides comprised of algae and infectious bacteria. Karenia brevis,
a microscopic marine algae found in red tide, can trigger eye and respiratory ir-
ritation that, in people with severe respiratory conditions, may provoke strong
adverse reactions. Although they were once unusual, today red tides have become
common and annually contribute to illness and death among those who consume
contaminated fish and shellfish. As this example suggests, humans are having
an ever more dramatic adverse impact on the environment, including behaviors
that boost the spread and human exposure to infectious diseases.
Pulling the various threads of this discussion together, the biocultural/
biosocial conceptualization of infectious disease recognizes that in all cases
a complex interplay of biological, social, cultural, and environmental factors
36 ❋ ch a p t er o ne

underlies the appearance, natural history, virulence, and outcomes of agent-

related disease. There is a real sense in which there is an inseparability of envi-
ronmental, social, cultural, and biological factors. All of these participate in an
ongoing co-evolutionary transformation.
As a result, it is not really quite accurate to assert, despite its frequent appear-
ance in various health texts, that “tuberculosis is an infectious disease caused by
a bacterium called Mycobacterium tuberculosis” or “AIDS is a disease caused by
a virus called HIV (human immunodeficiency virus).” As we have seen, neither
of these diseases spread randomly in populations; patterns of infection change
over time and place, and even the virulence or actual disease expressions of in-
fectious agents varies in terms of both location and era of occurrence. Over time
infectious agents, cultural systems, and social structures continually undergo
reactive changes in response to each other and to changes in the environment,
which are often caused by sociocultural changes.
Despite recognition that biology is only one aspect of infection, a necessary
but insufficient explanation of its cause—it is important for anthropologists
working in this area to have a solid grounding in relevant biological factors,
including an understanding of the behavioral ecology of pathogens and vectors;
how these are influenced by the physical environment, including anthropogeni-
cally impacted environments; other species in the environment; pathogen-host
and pathogen-pathogen interactions; and the functioning of the multilayered
human immune system. These are issues of primary concern to other health
disciplines like epidemiology. Consequently anthropologists working on in-
fectious disease issues often have broad, multidisciplinary training. Medical
anthropologists frequently work in collaboration with epidemiologists, other
kinds of social and behavioral scientists, nurses, physicians, and people trained
in allied health fields. For example, in studies of HIV risk and strategies for
hepatitis B (HBV) vaccination among street injection drug users, the author
of this book worked with broad multidisciplinary teams of epidemiological and
other researchers (e.g., Grau et al. 2009; Singer et al. 2011).
In sum, as displayed in Table 1.1, from the anthropological perspective, an
infectious event is composed of a suite of interlocked components and cannot
be reduced to any one of them. Critical to the assessment of such an event is the
development of an understanding of the interaction among these components,
how they affect each other, not simply their nature as isolated features. As Lock
(2001:484) observes, “knowledge about biology is informed by the social and
the social is in turn informed by the reality of the material.”
Another way to describe the anthropological approach to infectious disease
is in terms of an infectious disease formula that identifies key heuristic compo-
nents in an interactive and interdependent process:
 defining the anthropology of infectious disease ❋ 37

Table 1.1 Components of the Anthropology of Infectious Disease

Biological Factors
Pathogens
Human Immune System
Overall health (nutrition, stress, chronic health problems, other infections)
Pathogen/host interaction


Environmental Factors
Food and water availability
Weather/Climate


Sociocultural Factors
Sociocultural systems seen as local or broader organized sets of knowledge, experi-
ence, attitudes, norms and behaviors that generate understanding of and respond to
disease
Sociocultural systems seen as forces and energy systems that impact environments
Sociocultural systems as historically rooted forces that structure social relationship,
exposure to disease, and access to resources
Patterns of globalization and the flow of commodities, people and disease

As this formula and the arrows within it suggest, infectious disease health
status is a reflection of dynamic interrelations among biological, environmental,
and social and cultural factors.

Constructing Disease, Knowing Infection

Infection, of course, is one type of a broader category of conditions that we

label disease. The term refers to conditions that impair normal tissue function.
Medical anthropology commonly differentiates disease, as a clinically identified
biological condition, from illness, which refers to the culturally shaped experi-
ence and meaning of being sick. Another way of phrasing this differentiation is
that sufferers and their social networks construct illnesses based on immediate
sensations and lived experiences and in terms of their cultural understandings.
Clinicians, by contrast, construct diseases based on patient reports of symptoms
as well as signs of biological disruptions provided by laboratory tests or direct
observations and in terms of their medical knowledge.
From an anthropological perspective it is possible to have a disease and
not experience illness. An example of this is found with sexually transmitted
infections like chlamydia. Chlamydia trachotais is a bacteria that enters the body
through sexual contact and in many cases spreads without producing experi-
enced symptoms. This stealth factor is the source of the bacteria’s name, which
is derived from the Greek word for “cloak.” It is estimated that three-quarters
38 ❋ ch a p t er o ne

of all infected females and half of infected males are unaware they have been
infected, although, if left untreated, chlamydia can cause pelvic inflammatory
disease, ectopic pregnancy, and infertility (Watson et al. 2002). Conversely,
it is possible to be ill but undiseased. A classic example is described by Baars
(1997:104), who notes that “medical students who study frightening diseases
for the first time routinely develop vivid delusions of having the ‘disease of the
week’—whatever they are currently studying.” Upon first learning of the local-
ized symptoms of pneumonia, students may report feeling discomfort in possible
sites of pneumonia infection and become convinced, at least temporarily, that
they have pneumonia.
It is also important to clarify the difference between infection and infectious
disease. The human body can be infected with the strains of mycobacteria that
have the capacity to cause tuberculosis but then not develop the disease because a
healthy immune system prevents the development of active tuberculosis disease.
An individual with latent tuberculosis cannot transmit the bacteria to others.
If the individual’s immune system subsequently is compromised by other dis-
eases, chemotherapy, malnutrition, aging, or other factors, latent tuberculosis
can become active and damaging to the sufferer’s health and be transmitted
to others. In other words, one can be infected with the pathogen that causes
tuberculosis and not suffer the disease. The term infection also is often used to
refer to very local manifestations of pathogen activity, such as occurs around
a small paper cut on a finger, that does not reach the adequate scale of spread
and damage to the body to be considered a disease. On a biological level the
basic processes are the same, but there is a cultural differentiation made on the
basis of perceived threat.
The labeling of one pathogen-related condition as an infection and another
as a disease also reflects other sociocultural factors. Historically, for example,
infections transmitted through intimate contact were labeled sexually transmit-
ted diseases (STDs). Given the cultural meanings and emotions evoked by the
word disease, including social stigmas that may lead sufferers to avoid treatment,
there has been a strong push in biomedicine and public health to replace the use
of STD with sexually transmitted infection (STI).
One challenge posed by the anthropological definition and, indeed, all
definitions of disease is that it is impossible to establish fully what normal tissue
function is. Complex conditions influence body tissue, including diet, genetics,
stress, toxic exposure, pathogens, environmental conditions, and social fac-
tors. In defining health, many people follow the World Health Organization’s
(1946) statement that health is a state of complete physical, mental, and social
well-being and not merely the absence of disease or infirmity. Although it is
useful to have this kind of starting point, it too leaves open what a complete
 defining the anthropology of infectious disease ❋ 39

state of well-being would be and whether it is in fact achievable. At a minimum

it is possible to recognize states of greater and lesser health and of the role that
infectious disease plays in our level of health at various scales (individual through
global) at any point in time.
Within biomedicine and beyond there has reigned a culturally rooted
imagery and lexicon of war in our understanding of infectious disease. As an-
thropologist Emily Martin (1990:421) observes, “As immunology describes it,
bodies are imperiled nations continuously at war to quell alien invaders. These
nations have sharply defined borders in space, which are constantly besieged
and threatened.” Bruce Albers and colleagues (2002:1487), for example, state,
“The development of the exquisitely precise adaptive immune system in verte-
brates . . . was an important escalation in the arms race that has always existed
between pathogens and their hosts.” There is nothing “natural,” however, about
viewing our relationship with pathogens as a kind of military struggle to de-
fend the homeland. Martin notes that one component of our immune system,
the macrophage white blood cell, consumes microbes. She argues, “If the view
that microorganisms serve as food for macrophages were given prominence,
we could see this process as a food chain, linked by mutual dependencies” in
a world in which all organisms are dependent on others for food. In this world
we consume other organisms, and they consume us at various scales. These are
natural processes that connect all life forms in complex ecological relationships.
Another way of thinking about infectious diseases is to view them in terms
of more immediate and more distal causes. As states of disrupted health, infec-
tious diseases involve impaired tissue function that is immediately or directly
caused by biological agents. In order to cause disease, pathogens must be able
to enter a person’s body, adhere to specific cells therein, colonize body tissues,
avoid or subvert the host’s immune system, and inflict damage on these tissues
as part of normal and natural processes of pathogen consumption and repro-
duction. Although the growth of pathogen densities may be enough to cause
tissue damage in some cases, the production of toxins or destructive enzymes
by the pathogen or by the immune response the body mounts often causes the
damage. For example, when the pathogen Mycobacterium tuberculosis enters a
person’s body, usually by inhaling the exhale of an already infected individual,
as noted above, macrophages detect and consume the bacterium. But rather
than being destroyed in this process, the microbe releases a substance known
as cyclic AMP, which allows it to avoid destruction and assume a protected
dormant state only to become active if the host’s immune system subsequently
is weakened. Yet this is only a proximate understanding of the situation. Nelson
Mandela, who spent twenty-seven years in prison for his efforts to overthrow
the racist apartheid government of South Africa, contracted tuberculosis while
40 ❋ ch a p t er o ne

in prison, where it is a common threat to health. Notably, Mandela announced

his condition during the 15th International AIDS Conference because tuber-
culosis, which kills almost 2 million people each year, is a leading cause of death
for people with HIV infection because it weakens the immune system. In his
remarks Mandela (quoted in Nakashima 2004) noted, “My friends objected to
me sharing my personal affairs,” referencing the stigma attached to tuberculo-
sis in many countries, where it is seen as a disease of the poor. As this example
suggests, ultimate causes, like the use of imprisonment to control oppressed
populations and cultural factors like stigmatization of disease, are not only of
keen interest to anthropologists but also critical components of tuberculosis
infection as well as other infection diseases. They are, as Geoffrey Rose (1992)
expressed it, “the causes of the causes”—the distal factors that enable the proxi-
mal causes. More distal and proximate causes of infectious disease comprise
an ecological web of causation that includes social, cultural, environmental, and
biological components (Mayer 2000).
Paul Brown and colleagues (2012) maintain that human social and cultural
systems have three fundamental roles in determining the patterns of disease and
death in a population: (1) they shape behaviors, such as diet, sexual practice,
and land use, that expose people to infections or shield them from them; (2)
they reshape the physical environment in ways that affect human susceptibility
to infections; and (3) they influence human responses to infectious disease and
both facilitate health improvements and exacerbate disease burdens. To this list,
two additional items can be added: (4) they have evolutionary impacts on our
bodies that influence our interaction with infectious diseases, as discussed below
with regard to the role of culture in reductions in our hairiness and exposure to
ectoparasites, and (5) they play a role in changing pathogens, and these changes,
in turn, rebound on us in our continued interaction with them.

What Counts in Infectious Disease?

How important are infectious diseases in human health? The ways we under-
stand this question and respond to it also reflect sociocultural practices. Looking
a two profoundly important current infectious diseases, according to the World
Health Organization (2013a), almost 70 million people worldwide have been
infected with the HIV virus, and about 35 million of them have died of HIV
disease. At the end of 2011 it was estimated that there were 34.0 million people
in the world living with HIV infection, or 0.8 percent of adults aged fifteen to
forty-nine years, with considerable variance between countries and regions. The
World Health Organization (2012a) also reports that the global tuberculosis
rates have been falling for several years and decreased by a rate of 2.2 percent
 defining the anthropology of infectious disease ❋ 41

between 2010 and 2011. At the country level the World Health Organization
points to Cambodia as an example of what can be achieved in a low-income and
high-burden country, as Cambodia reports a 45 percent decrease in tuberculosis
prevalence since 2002.
We are very familiar with health statistics like those reported above. They
regularly show up in mass media accounts of epidemics and other health issues.
They are used in this public venue to affirm how significant a health problem
has become or that substantial health improvements have been achieved. The
epidemiological and public health reporting of infectious disease outbreaks and
prevalences, in terms of precise numbers of cases and related quantitative infor-
mation about the characteristics of sufferers or regional distributions, reflects
a social reliance on seemingly objective figures and processes of enumeration.
Although tallies like those for HIV and tuberculosis reported above are used
in decision making about where to direct limited resources in public health
programming and what issues to focus on in public health education, from an
anthropological perspective, based on on-the-ground experience in the study of
infectious outbreaks and epidemics, questions are raised about the production
of official statistics: Where do the numbers come from? How are they compiled,
by whom, under what conditions, with what uniformity, and using what criteria?
And, in light of these other questions, what do the numbers actually mean?
Here is an example of the importance of being cautious about official sta-
tistics. Mary Dixon-Woods and colleagues (2012) conducted an ethnographic
study in England on central-line infections, a hospital-acquired bacterial infec-
tion most commonly seen in intensive care patients with catheters inserted close
to their hearts. They found notable variation in social practices of data collec-
tion and reporting across hospitals, which, simply put, “were not counting the
same things in the same way” (Dixon-Woods et al. 2012:580). These variations
reflected a number of factors, such as whether hospital staff, who bore burden-
some workloads and needed to prioritize their efforts, viewed detailed record
keeping as a legitimate use of their limited available time. Long-established and
entrenched work patterns as well as clinician preferences also contributed to
considerable variability in case reporting.
In another take on the reliability of quantitative infectious disease data,
Kathleen Gallagher and colleagues (2003) compared information on over two
hundred HIV infection cases reported to the Massachusetts Department of
Public Health to the original medical records for these cases at the site of patient
diagnosis. They found that although routine AIDS surveillance data were reliable
for demographic variables (e.g., patient age, gender), they were less reliable for
information about clinical events, laboratory findings, or, especially, treatments
patients had received. In infectious disease epidemics numbers often are based
42 ❋ ch a p t er o ne

on what is known as “passive reporting,” which is based on cases seen in health

facilities. But passive reporting is burdened with multiple shortcomings. As the
World Health Organization (2013b) recognizes with reference to epidemic-
prone infectious diseases, in various places in the world there is inadequate
access to health care facilities. Many people become sick and die without ever
visiting a health care facility, so their cases are never reported. Additionally,
many diseases are underrecognized. This is especially the case with diseases
with nonspecific symptoms or those that are new to a region. These problems
are magnified by the fact that in lesser-developed countries the level of labora-
tory support needed for diagnosis is poor, clinical and laboratory staff may be
underpaid and overworked, and training is limited. As a result, considerable
variation can be found in the quality of reporting systems from country to coun-
try and between urban and more rural areas, reflecting the significant effects
on official statistics of economic, social, cultural, and epidemiological factors.
This discussion reveals that health statistics are more than what they seem
because they always are socially produced and, hence, are influenced by a wide
array of human, cultural, institutional, structural, and situational factors. As
anthropologist Didier Fassin (2004:169) emphasizes, health problems “are not
only biological realities that specialists elucidate, they are also epidemiological
facts that they construct.” In assessing statistics on infectious disease it is not
possible to parse biology from cultural conditions and social influences. In HIV
disease, for example, the way health professionals had defined “AIDS” early in
the epidemic precluded the counting of many cases among women, who suf-
fered from opportunistic infections that were not recognized as “AIDS related.”
Consequently, from an anthropological perspective it is always necessary to not
take the numbers or even the categories used in epidemiological reporting on
infectious diseases at face value as neutral statements about objective realities.
Subjecting the numbers as well as what is being counted (and not counted) to
scrutiny in light of the influence of social and cultural factors is routine anthro-
pological practice.

The Wider Contexts of Infectious

Disease Outbreaks

There is an identifiable relationship between infectious diseases—including

who gets which disease, how sick they get, and the outcomes of their sickness—
and the hierarchy of social relationships structured by inequalities in wealth
and power within and across societies (Baer, Singer, and Susser 2013; Farmer
1999). HIV disease, for instance, has tended to spread “along the fault lines of
. . . society” (Bateson and Goldsby 1988:2). Although first identified among
 defining the anthropology of infectious disease ❋ 43

gay men in the United States, HIV disease soon became disproportionately
frequent in low-income and socially subordinated communities of color. This
pattern of disease spread was not random, nor was it the consequence of biology;
rather, it reflects the fact that infectious disease spread is socially determined.
HIV infection interacts with human societies and the social relationships that
constitute them to create the global “HIV disease pandemic,” which is the
worldwide pattern of distribution of the disease and the social responses that
have developed around it in particular groups and populations. Glaring social
disparities between dominant versus subordinate groups and wealthy versus
impoverished populations in the distribution of HIV disease as well as in access
to available treatment have typified the pandemic. The relationship between
poor health and poverty is a consequence of multiple biocultural/biosocial
factors, including “weakened immunity and neurophysiological development
because of malnutrition, ease of spread of pathogens because of insalubrious
living conditions, and the precariousness of social support networks” (Nguyen
and Peschard 2003:449) (see Figure 1.1).
Beyond poverty, other forms of social discrimination, marginalization,
structural violence, and assaults on human dignity also are essential factors in
the development and spread of infectious diseases, as discussed in greater detail
in Chapter 7. Further, as Shirley Lindenbaum (2001:380) comments, the study
of infectious disease epidemics “provides a unique point of entry for examining

Figure 1.1 Early 20th century urban poverty.

44 ❋ ch a p t er o ne

the relationships among cultural assumptions, particular institutional forms,

and states of mind,” an issue addressed below.

Cultural Windows on Infection

People everywhere suffer from infectious disease, and because humans character-
istically respond to and understand life experience using socially acquired cultural
frameworks, all societies have developed local knowledge about infection and
healing practices, including culturally constructed understandings that may differ
from biomedical models of infection. Even in the West, the broad adoption of the
biomedical germ theory model of infection took time and, in some ways, remains
less than fully complete, a fact revealed in times of infectious disease panics.
For example, during a global pandemic of influenza in the early twentieth
century that killed as many as 50 to 100 million people worldwide, countless
local health strategies were used to try to protect or cure people. In Utah, which
had the third highest rate of death of US states, archival records show that people
made use of a mixture of home and doctor remedies. Alcohol, normally banned
in the largely Mormon state, was sold to doctors to treat patients. Some parents
hung bags of herbs around children’s necks to prevent influenza (Department
of Health and Human Services n.d.). Many people understood from health
authorities that “germs” caused the disease but were not completely sure what
germs were or how they were transmitted from one person to another. To feel
safe, families locked themselves in their homes and sealed their keyholes and
the cracks around their doors with cotton. Utah public health officials enacted
laws requiring citizens to wear gauze masks. Some towns required anyone en-
tering their municipalities to possess a certificate signed by a doctor affirming
that they were symptom-free. Railroads were warned not to accept passengers
without such a certificate, and all passengers wore masks; streetcar conductors
were told to limit their passengers; and stores were banned from holding sales.
Following a ban on public assemblies, police began making arrests of people for
gathering together in small groups (e.g., to play a game of cards). In the town of
Cedar City a parade celebrating the end World War I featured a statue of Lady
Liberty wearing a mask to publicize this strategy for controlling the spread
of disease. Although we know that such masks do not prevent infection, even
today graphic news coverage of disease outbreaks around the world reveals the
widespread belief that they are protective.
Anthropologists are demonstrating the great diversity of beliefs about
disease as well as the many kinds of treatments people use outside of clinical set-
tings. In a study of Hispanic HIV infection patients receiving care at a biomedical
clinic in New Jersey, for example, Mariana Suarez and coworkers (1996) found
Exploring the Variety of Random
Documents with Different Content
The Project Gutenberg eBook of A Year with a
Whaler
This ebook is for the use of anyone anywhere in the United States
and most other parts of the world at no cost and with almost no
restrictions whatsoever. You may copy it, give it away or re-use it
under the terms of the Project Gutenberg License included with this
ebook or online at www.gutenberg.org. If you are not located in the
United States, you will have to check the laws of the country where
you are located before using this eBook.

Title: A Year with a Whaler

Author: Walter Noble Burns

Release date: September 15, 2020 [eBook #63211]

Most recently updated: October 18, 2024

Language: English

Credits: Produced by TCosmas and the Online Distributed

Proofreading
Team at https://www.pgdp.net (This file was produced
from
images generously made available by The Internet Archive)

*** START OF THE PROJECT GUTENBERG EBOOK A YEAR WITH A

WHALER ***
A YEAR WITH A WHALER

"Cutting Out" A Whale

A YEAR WITH A
WHALER
BY
 WALTER NOBLE BURNS

Illustrated with Photographs

NEW YORK
OUTING PUBLISHING COMPANY
MCMXIII

Copyright, 1913, BY
OUTING PUBLISHING COMPANY
All rights reserved
 CONTENTS
CHAPTER PAGE
I.The Lure of the Outfitter 11
II. The Men of the "Alexander" 21
III.Why We Don't Desert 33
IV. Turtles and Porpoises 46
V. The A, B, C of Whales 59
VI. The Night King 71
VII. Dreams of Liberty 83
VIII. Gabriel's Little Drama 95
IX. Through the Roaring Forties 107
X. In the Ice 118
XI. Cross Country Whaling 128
XII. Cutting In and Trying Out 137
XIII. Shaking Hands with Siberia 149
XIV. Moonshine and Hygiene 162
XV. News From Home 171
XVI. Slim Goes on Strike 182
XVII. Into the Arctic 191
XVIII. Blubber and Song 198
XIX. A Narrow Pinch 210
XX. A Race and a Race Horse 219
XXI. Bears for a Change 230
XXII. The Stranded Whale 239
XXIII. And So—Home 247
 ILLUSTRATIONS
"Cutting Out" a Whale Frontispiece
FACING PAGE
In Bowhead Waters 16
When Whaling is an Easy Job 40
Waiting for the Whale to Breach 72
Unalaska 112
Waiting for the Floes to Open 120
"Trying Out" 144
Callers From Asia 152
Peter's Sweetheart 160
Eskimos Summer Hut at St. Lawrence Bay 168
At the Gateway to the Arctic 176
Hoisting the Blubber Aboard 184
Our Guests Coming Aboard in St. Lawrence Bay 192
The Lip of a Bowhead Whale 208
A Close Call Off Herald Island 216
Skin Boat of the Siberian Eskimos 240
A YEAR WITH A WHALER

A Year With A Whaler

 CHAPTER I
THE LURE OF THE OUTFITTER
When the brig Alexander sailed out of San Francisco on a whaling
voyage a few years ago, I was a member of her forecastle crew.
Once outside the Golden Gate, I felt the swing of blue water under
me for the first time in my life. I was not shanghaied. Let's have that
settled at the start. I had shipped as a green hand before the mast
for the adventure of the thing, because I wanted to go, for the
glamor of the sea was upon me.
I was taking breakfast in a San Francisco restaurant when, in
glancing over the morning paper, I chanced across this
advertisement:
Wanted—Men for a whaling voyage; able seamen,
ordinary seamen, and green hands. No experience
necessary. Big money for a lucky voyage. Apply at Levy's,
No. 12 Washington Street.
Until that moment I had never dreamed of going to sea, but that
small "ad." laid its spell upon my imagination. It was big with the
lure of strange lands and climes, romance and fresh experiences.
What did it matter that I had passed all my humdrum days on dry
land? "No experience necessary!" There were the magic words
staring me in the face. I gulped down my eggs and coffee and was
off for the street called Washington.
Levy's was a ship's outfitting store. A "runner" for the house—a
hulking man with crafty eyes and a face almost as red as his hair
and mustache—met me as I stepped in the door. He looked me over
critically. His visual inventory must have been satisfactory. I was
young.
"Ever been a sailor?" he asked.
"No."
"Makes no difference. Can you pull an oar?"
"Yes."
"You'll do. Hang around the store to-day and I'll see what vessels
are shipping crews."
That was all. I was a potential whaler from that minute.
A young working man in overalls and flannel shirt came in later in
the day and applied to go on the voyage. He qualified as a green
hand. But no spirit of adventure had brought him to Levy's. A
whaling voyage appealed to his canny mind as a business
proposition.
"What can we make?" he asked the runner.
"If your ship is lucky," replied the runner, "you ought to clean up
a pile of money. You'll ship on the 190th lay. Know what a lay is? It's
your per cent. of the profits of the voyage. Say your ship catches
four whales. She ought to catch a dozen if she has good luck. But
say she catches four. Her cargo in oil and bone will be worth about
$50,000. Your share will amount to something like $200, and you'll
get it in a lump sum when you get back."
This was "bunk talk"—a "springe to catch woodcock"—but we did
not know it. That fluent and plausible man took pencil and paper
and showed us just how it would all work out. It was reserved for us
poor greenhorns to learn later on that sailors of whaling ships
usually are paid off at the end of a voyage with "one big iron dollar."
This fact being discreetly withheld from us, our illusions were not
disturbed.
 The fact is the "lay" means nothing to sailors on a whaler. It is
merely a lure for the unsophisticated. It might as well be the 1000th
lay as the 190th, for all the poor devil of a sailor gets. The
explanation is simple. The men start the voyage with an insufficient
supply of clothing. By the time the vessel strikes cold weather their
clothes are worn out and it is a case of buy clothes from the ship's
slop-chest at the captain's own prices or freeze. As a consequence,
the men come back to port with expense accounts standing against
them which wipe out all possible profits. This has become so
definitely a part of whaling custom that no sailor ever thinks of
fighting against it, and it probably would do him no good if he did.
As a forecastle hand's pay the "big iron dollar" is a whaling tradition
and as fixed and inevitable as fate.
The outfitter who owned the store did not conduct a sailor's
boarding house, so we were put up at a cheap hotel on Pacific
street. After supper, my new friend took me for a visit to the home
of his uncle in the Tar Flats region. A rough, kindly old laboring man
was this uncle who sat in his snug parlor in his shirt sleeves during
our stay, sent one of the children to the corner for a growler of beer,
and told us bluntly we were idiots to think of shipping on a whaling
voyage. We laughed at his warning—we were going and that's all
there was to it. The old fellow's pretty daughters played the piano
and sang for us, and my last evening on shore passed pleasantly
enough. When it came time to say good-bye, the uncle prevailed on
my friend to stay all night on the plea that he had some urgent
matters to talk over, and I went back alone to my dingy hotel on the
Barbary Coast.
I was awakened suddenly out of a sound sleep in the middle of
the night. My friend stood beside my bed with a lighted candle in his
hand.
"Get up and come with me," he said. "Don't go whaling. My uncle
has told me all about it. He knows. You'll be treated like a dog
aboard, fed on rotten grub, and if you don't die under the hard
knocks or freeze to death in the Arctic Ocean, you won't get a penny
when you get back. Don't be a fool. Take my advice and give that
runner the slip. If you go, you'll regret it to the last day of your life."
In the yellow glare of the candle, the young man seemed not
unlike an apparition and he delivered his message of warning with
prophetic solemnity and impressiveness. But my mind was made up.
"I guess I'll go," I said.
He argued and pleaded with me, all to no purpose. He set the
candle on the table and blew it out.
"You won't come?" he said out of the darkness.
"No."
"You're a fool."
He slammed the door. I never saw him again. But many a time
on the long voyage I recalled his wise counsel, prompted as it was
by pure friendliness, and wished from my heart I had taken his
advice.
 In Bowhead Waters

Next day the runner for Levy's tried to ship me aboard the steam
whaler William Lewis. When we arrived at the shipping office on the
water front, it was crowded with sailors and rough fellows, many of
them half drunk, and all eager for a chance to land a berth. A
bronzed and bearded man stood beside a desk and surveyed them.
He was the skipper of the steamer. The men were pushing and
elbowing in an effort to get to the front and catch his eye.
"I've been north before, captain," "I'm an able seaman, sir," "I
know the ropes," "Give me a chance, captain," "Take me, sir; I'll
make a good hand,"—so they clamored their virtues noisily. The
captain chose this man and that. In twenty minutes his crew was
signed. It was not a question of getting enough men; it was a mere
matter of selection. In such a crowd of sailormen, I stood no show.
In looking back on it all, I wonder how such shipping office scenes
are possible, how men of ordinary intelligence are herded aboard
whale ships like sheep, how they even fight for a chance to go.
 It was just as well I failed to ship aboard the William Lewis. The
vessel went to pieces in the ice on the north Alaskan coast the
following spring. Four men lost their lives and only after a bitter
experience as castaways on the floes were the others rescued.
That afternoon Captain Shorey of the brig Alexander visited
Levy's. I was called to his attention as a likely young hand and he
shipped me as a member of his crew. I signed articles for a year's
voyage. It was provided that I was to receive a $50 advance with
which to outfit myself for the voyage; of course, any money left over
after all necessary articles had been purchased was to be mine—at
least, in my innocence, I imagined it was.
The brig was lying in the stream off Goat Island and the runner
set about the work of outfitting me at once. He and I and a clerk
went about the store from shelf to shelf, selecting articles. The
runner carried a pad of paper on which he marked down the cost. I
was given a sailor's canvas bag, a mattress, a pair of blankets,
woolen trousers, dungaree trousers, a coat, a pair of brogans, a pair
of rubber sea boots, underwear, socks, two flannel shirts, a cap, a
belt and sheath knife, a suit of oil-skins and sou'wester, a tin cup, tin
pan, knife, fork and spoon. That was all. It struck me as a rather
slender equipment for a year's voyage. The runner footed up the
cost.
"Why," he said with an air of great surprise, "this foots up to $53
and your advance is only $50."
He added up the column of figures again. But he had made no
mistake. He seemed perplexed.
"I don't see how it is possible to scratch off anything," he said.
"You'll need every one of these articles."
He puckered his brow, bit the end of his pencil, and studied the
figures. It was evidently a puzzling problem.
 "Well," he said at last, "I'll tell you what I'll do. Bring me down a
few curios from the Arctic and I'll call it square."
I suppose my outfit was really worth about $6—not over $10. As
soon as my bag had been packed, I was escorted to the wharf by
the runner and rowed out to the brig. As I prepared to climb over
the ship's rail, the runner shook me by the hand and clapped me on
the back with a great show of cordial goodfellowship.
"Don't forget my curios," he said.
 CHAPTER II
THE MEN OF THE "ALEXANDER"
The brig Alexander was a staunch, sea-worthy little vessel. She
had no fine lines; there was nothing about her to please a
yachtsman's eye; but she was far from being a tub as whaling ships
are often pictured. She was built at New Bedford especially for Arctic
whaling. Her hull was of sturdy oak, reinforced at the bows to enable
her to buck her way through ice.
Though she was called a brig, she was really a brigantine, rigged
with square sails on her fore-mast and with fore-and-aft sails on her
main. She was of only 128 tons but quite lofty, her royal yard being
eighty feet above the deck. On her fore-mast she carried a fore-sail,
a single topsail, a fore-top-gallant sail, and a royal; on her main-
mast, a big mainsail with a gaff-topsail above it. Three whale boats
—starboard, larboard, and waist boats—hung at her davits.
Amidships stood the brick try-works equipped with furnaces and
cauldrons for rendering blubber into oil.
As soon as I arrived on board I was taken in charge by the ship
keeper and conducted to the forecastle. It was a dark, malodorous,
triangular hole below the deck in the bows. At the foot of the ladder-
like stairs, leading down through the scuttle, I stepped on something
soft and yielding. Was it possible, I wondered in an instant's flash of
surprise, that the forecastle was laid with a velvet carpet? No, it was
not. It was only a Kanaka sailor lying on the floor dead drunk. The
bunks were ranged round the walls in a double tier. I selected one
for myself, arranged my mattress and blankets, and threw my bag
inside. I was glad to get back to fresh air on deck as quickly as
possible.
 Members of the crew kept coming aboard in charge of runners
and boarding bosses. They were a hard looking lot; several were
staggering drunk, and most of them were tipsy. All had bottles and
demijohns of whiskey. Everybody was full of bad liquor and high
spirits that first night on the brig. A company of jolly sea rovers were
we, and we joked and laughed and roared out songs like so many
pirates about to cruise for treasure galleons on the Spanish Main.
Somehow next morning the rose color had faded out of the prospect
and there were many aching heads aboard.
On the morning of the second day, the officers came out to the
vessel. A tug puffed alongside and made fast to us with a cable. The
anchor was heaved up and, with the tug towing us, we headed for
the Golden Gate. Outside the harbor heads, the tug cast loose and
put back into the bay in a cloud of smoke. The brig was left swinging
on the long swells of the Pacific.
The captain stopped pacing up and down the quarter-deck and
said something to the mate. His words seemed like a match to
powder. Immediately the mate began roaring out orders. Boat-
steerers bounded forward, shouting out the orders in turn. The old
sailors sang them out in repetition. Men sprang aloft. Loosened sails
were soon rolling down and fluttering from every spar. The sailors
began pulling on halyards and yo-hoing on sheets. Throughout the
work of setting sail, the green hands were "at sea" in a double
sense. The bustle and apparent confusion of the scene seemed to
savor of bedlam broke loose. The orders were Greek to them. They
stood about, bewildered and helpless. Whenever they tried to help
the sailors they invariably snarled things up and were roundly
abused for their pains. One might fancy they could at least have
helped pull on a rope. They couldn't even do that. Pulling on a rope,
sailor-fashion, is in itself an art.
Finally all the sails were sheeted home. Ropes were coiled up and
hung neatly on belaying pins. A fresh breeze set all the snowy
canvas drawing and the brig, all snug and shipshape, went careering
southward.
 At the outset of the voyage, the crew consisted of twenty-four
men. Fourteen men were in the forecastle. The after-crew comprised
the captain, mate, second mate, third mate, two boat-steerers,
steward, cooper, cook, and cabin boy. Captain Shorey was not
aboard. He was to join the vessel at Honolulu. Mr. Winchester, the
mate, took the brig to the Hawaiian Islands as captain. This
necessitated a graduated rise in authority all along the line. Mr.
Landers, who had shipped as second mate, became mate; Gabriel,
the regular third mate, became second mate; and Mendez, a
boatsteerer, was advanced to the position of third mate.
Captain Winchester was a tall, spare, vigorous man with a nose
like Julius Caesar's and a cavernous bass voice that boomed like a
sunset gun. He was a man of some education, which is a rarity
among officers of whale ships, and was a typical New England
Yankee. He had run away to sea as a boy and had been engaged in
the whaling trade for twenty years. For thirteen years, he had been
sailing to the Arctic Ocean as master and mate of vessels, and was
ingrained with the autocratic traditions of the quarter-deck. Though
every inch a sea dog of the hard, old-fashioned school, he had his
kindly human side, as I learned later. He was by far the best
whaleman aboard the brig; as skillful and daring as any that ever
laid a boat on a whale's back; a fine, bold, hardy type of seaman
and an honor to the best traditions of the sea. He lost his life—poor
fellow—in a whaling adventure in the Arctic Ocean on his next
voyage.
Mr. Landers, the mate, was verging on sixty; his beard was
grizzled, but there wasn't a streak of gray in his coal-black hair. He
was stout and heavy-limbed and must have been remarkably strong
in his youth. He was a Cape Codder and talked with a quaint, nasal,
Yankee drawl. He had been to sea all his life and was a whaleman of
thirty years' experience. In all these years, he had been ashore very
little—only a few weeks between his year-long voyages, during
which time, it was said, he kept up his preference for liquids,
exchanging blue water for red liquor. He was a picturesque old
fellow, and was so accustomed to the swinging deck of a ship under
him that standing or sitting, in perfectly still weather or with the
vessel lying motionless at anchor, he swayed his body from side to
side heavily as if in answer to the rise and fall of waves. He was a
silent, easy-going man, with a fund of dry humor and hard common
sense. He never did any more work than he had to, and before the
voyage ended, he was suspected by the officers of being a
malingerer. All the sailors liked him.
Gabriel, the second mate, was a negro from the Cape Verde
islands. His native language was Portuguese and he talked funny,
broken English. He was about forty-five years old, and though he
was almost as dark-skinned as any Ethiopian, he had hair and a full
beard as finely spun and free from kinkiness as a Caucasian's. The
sailors used to say that Gabriel was a white man born black by
accident. He was a kindly, cheerful soul with shrewd native wit. He
was a whaleman of life-long experience.
Mendez, the third mate, and Long John, one of the boatsteerers,
were also Cape Verde islanders. Long John was a giant, standing six
feet, four inches; an ungainly, powerful fellow, with a black face as
big as a ham and not much more expressive. He had the reputation
of being one of the most expert harpooners of the Arctic Ocean
whaling fleet.
Little Johnny, the other boatsteerer, was a mulatto from the
Barbadoes, English islands of the West Indies. He was a strapping,
intelligent young man, brimming over with vitality and high spirits
and with all a plantation darky's love of fun. His eyes were bright
and his cheeks ruddy with perfect health; he loved dress and gay
colors and was quite the dandy of the crew.
Five of the men of the forecastle were deep-water sailors. Of
these one was an American, one a German, one a Norwegian, and
two Swedes. They followed the sea for a living and had been
bunkoed by their boarding bosses into believing they would make
large sums of money whaling. They had been taken in by a
confidence game as artfully as the man who loses his money at the
immemorial trick of three shells and a pea. When they learned they
would get only a dollar at the end of the voyage and contemplated
the loss of an entire working year, they were full of resentment and
righteous, though futile, anger.
Taylor, the American, became the acknowledged leader of the
forecastle. He quickly established himself in this position, not only by
his skill and long experience as a seaman, but by his aggressiveness,
his domineering character, and his physical ability to deal with men
and situations. He was a bold, iron-fisted fellow to whom the green
hands looked for instruction and advice, whom several secretly
feared, and for whom all had a wholesome respect.
Nels Nelson, a red-haired, red-bearded old Swede, was the best
sailor aboard. He had had a thousand adventures on all the seas of
all the world. He had been around Cape Horn seven times—a sailor
is not rated as a really-truly sailor until he has made a passage
around that stormy promontory—and he had rounded the Cape of
Good Hope so many times he had lost the count. He had ridden out
a typhoon on the coast of Japan and had been driven ashore by a
hurricane in the West Indies. He had sailed on an expedition to
Cocos Island, that realm of mystery and romance, to try to lift pirate
treasure in doubloons, plate, and pieces-of-eight, supposed to have
been buried there by "Bugs" Thompson and Benito Bonito, those
one-time terrors of the Spanish Main. He had been cast away in the
South Seas in an open boat with three companions, and had eaten
the flesh of the man whose fate had been sealed by the casting of
lots. He was some man, was Nelson. I sometimes vaguely suspected
he was some liar, too, but I don't know. I think most of his stories
were true.
He could do deftly everything intricate and subtle in sailorcraft
from tying the most wonderful knots to splicing wire. None of the
officers could teach old Nelson anything about fancy sailorizing and
they knew it. Whenever they wanted an unusual or particularly
difficult piece of work done they called on him, and he always did it
in the best seamanly fashion.
Richard, the German, was a sturdy, manly young chap who had
served in the German navy. He was well educated and a smart
seaman. Ole Oleson, the Norwegian, was just out of his teens but a
fine sailor. Peter Swenson, a Swede, was a chubby, rosy boy of
sixteen, an ignorant, reckless, devil-may-care lad, who was looked
upon as the baby of the forecastle and humored and spoiled
accordingly.
Among the six white green hands, there was a "mule skinner"
from western railway construction camps; a cowboy who believed
himself fitted for the sea after years of experience on the "hurricane
deck" of a bucking broncho; a country boy straight from the plow
and with "farmer" stamped all over him in letters of light; a man
suspected of having had trouble with the police; another who, in
lazy night watches, spun frank yarns of burglaries; and "Slim," an
Irishman who said he had served with the Royal Life Guards in the
English army. There was one old whaler. He was a shiftless,
loquacious product of city slums. This was his seventh whaling
voyage—which would seem sufficient comment on his character.
"It beats hoboing," he said. And as his life's ambition seemed
centered on three meals a day and a bunk to sleep in, perhaps it
did.
Two Kanakas completed the forecastle crew. These and the cabin
boy, who was also a Kanaka, talked fair English, but among
themselves they always spoke their native language. I had heard
much of the liquid beauty of the Kanaka tongue. It was a surprise to
find it the most unmusical and harshly guttural language I ever
heard. It comes from the mouth in a series of explosive grunts and
gibberings. The listener is distinctly and painfully impressed with the
idea that if the nitroglycerine words were retained in the system,
they would prove dangerous to health and is fearful lest they choke
the spluttering Kanaka to death before he succeeds in biting them
off and flinging them into the atmosphere.
 CHAPTER III
WHY WE DON'T DESERT
As soon as we were under sail, the crew was called aft and the
watches selected. Gabriel was to head the starboard watch and
Mendez the port. The men were ranged in line and the heads of the
watches made their selections, turn and turn about. The deep-water
sailors were the first to be chosen. The green hands were picked for
their appearance of strength and activity. I fell into the port watch.
Sea watches were now set—four hours for sleep and four for
work throughout the twenty-four. My watch was sent below. No one
slept during this first watch below, but we made up for lost time
during our second turn. Soon we became accustomed to the routine
and found it as restful as the usual landsman's method of eight
hours' sleep and sixteen of wakefulness.
It is difficult for a landlubber to understand how sailors on
shipboard can be kept constantly busy. The brig was a veritable hive
of industry. The watch on deck when morning broke pumped ship
and swept and flushed down the decks. During the day watches, in
addition to working the ship, we were continuously breaking out
supplies, keeping the water barrel on deck filled from casks in the
hold, laboring with the cargo, scrubbing paint work, polishing brass
work, slushing masts and spars, repairing rigging, and attending to a
hundred and one details that must be looked after every day. The
captain of a ship is one of the most scrupulous housekeepers in the
world, and only by keeping his crew busy from morning till night is
he able to keep his ship spick and span and in proper repair. Whale
ships are supposed to be dirty. On the contrary, they are kept as
clean as water and brooms and hard work can keep them.
 The food served aboard the brig was nothing to brag about.
Breakfast consisted of corned-beef hash, hardtack, and coffee
without milk or sugar. We sweetened our coffee with molasses, a
keg of which was kept in the forecastle. For dinner, we had soup,
corned-beef stew, called "skouse," a loaf of soft bread, and coffee.
For supper, we had slices of corned-beef which the sailors called
"salt horse," hardtack, and tea. The principal variation in this diet
was in the soups.
The days were a round of barley soup, bean soup, pea soup, and
back to barley soup again, an alternation that led the men to speak
of the days of the week not as Monday, Tuesday, and so on, but as
"barley soup day," "bean soup day," and "pea soup day." Once or
twice a week we had gingerbread for supper. On the other hand the
cabin fared sumptuously on canned vegetables, meat, salmon, soft
bread, tea, and coffee with sugar and condensed milk, fresh fish and
meat whenever procurable, and a dessert every day at dinner,
including plum duff, a famous sea delicacy which never in all the
voyage found its way forward.
From the first day, the green hands were set learning the ropes,
to stand lookout, to take their trick at the wheel, to reef and furl and
work among the sails. These things are the A B C of seamanship,
but they are not to be learned in a day or a week. A ship is a
complicated mechanism, and it takes a long time for a novice to
acquire even the rudiments of sea education. Going aloft was a
terrifying ordeal at first to several of the green hands, though it
never bothered me. When the cowboy was first ordered to furl the
fore-royal, he hung back and said, "I can't" and "I'll fall," and
whimpered and begged to be let off. But he was forced to try. He
climbed the ratlines slowly and painfully to the royal yard, and he
finally furled the sail, though it took him a long time to do it. He felt
so elated that after that he wanted to furl the royal every time it had
to be done;—didn't want to give anyone else a chance.
Furling the royal was a one-man job. The foot-rope was only a
few feet below the yard, and if a man stood straight on it, the yard
would strike him a little above the knees. If the ship were pitching, a
fellow had to look sharp or he would be thrown off;—if that had
happened it was a nice, straight fall of eighty feet to the deck. My
own first experience on the royal yard gave me an exciting fifteen
minutes. The ship seemed to be fighting me and devoting an
unpleasant amount of time and effort to it; bucking and tossing as if
with a sentient determination to shake me off into the atmosphere. I
escaped becoming a grease spot on the deck of the brig only by
hugging the yard as if it were a sweetheart and hanging on for dear
life. I became in time quite an expert at furling the sail.
Standing lookout was the one thing aboard a green hand could
do as well as an old sailor. The lookout was posted on the forecastle-
head in fair weather and on the try-works in a storm. He stood two
hours at a stretch. He had to scan the sea ahead closely and if a sail
or anything unusual appeared, he reported to the officer of the
watch.
Learning to steer by the compass was comparatively easy. With
the ship heading on a course, it was not difficult by manipulating the
wheel to keep the needle of the compass on a given point. But to
steer by the wind was hard to learn and is sometimes a nice matter
even for skillful seamen. When a ship is close-hauled and sailing, as
sailors say, right in the wind's eye, the wind is blowing into the
braced sails at the weather edge of the canvas;—if the vessel were
brought any higher up, the wind would pour around on the back of
the sails. The helmsman's aim is to keep the luff of the royal sail or
of the sails that happen to be set, wrinkling and loose—luffing,
sailors call it. That shows that the wind is slanting into the sails at
just the right angle and perhaps a little bit is spilling over. I gradually
learned to do this in the daytime. But at night when it was almost
impossible for me to see the luff of the sails clearly, it was extremely
difficult and I got into trouble more than once by my clumsiness.
The trick at the wheel was of two hours' duration.
The second day out from San Francisco was Christmas. I had
often read that Christmas was a season of good cheer and
happiness among sailors at sea, that it was commemorated with
religious service, and that the skipper sent forward grog and plum
duff to gladden the hearts of the sailormen. But Santa Claus forgot
the sailors on the brig. Bean soup only distinguished Christmas from
the day that had gone before and the day that came after. No liquor
or tempting dishes came to the forecastle. It was the usual day of
hard work from dawn to dark.
After two weeks of variable weather during which we were often
becalmed, we put into Turtle bay, midway down the coast of Lower
California, and dropped anchor.
Turtle bay is a beautiful little land-locked harbor on an
uninhabited coast. There was no village or any human habitation on
its shores. A desolate, treeless country, seamed by gullies and
scantily covered with sun-dried grass, rolled away to a chain of high
mountains which forms the backbone of the peninsula of Lower
California. These mountains were perhaps thirty miles from the
coast; they were gray and apparently barren of trees or any sort of
herbage, and looked to be ridges of naked granite. The desert
character of the landscape was a surprise, as we were almost within
the tropics.
We spent three weeks of hard work in Turtle bay. Sea watches
were abolished and all hands were called on deck at dawn and kept
busy until sundown. The experienced sailors were employed as sail
makers; squatting all day on the quarter-deck, sewing on canvas
with a palm and needle. Old sails were sent down from the spars
and patched and repaired. If they were too far gone, new sails were
bent in their stead. The green hands had the hard work. They broke
out the hold and restowed every piece of cargo, arranging it so that
the vessel rode on a perfectly even keel. Yards and masts were
slushed, the rigging was tarred, and the ship was painted inside and
out.
The waters of the harbor were alive with Spanish mackerel,
albacore, rock bass, bonitos, and other kinds of fish. The mackerel
appeared in great schools that rippled the water as if a strong
breeze were blowing. These fish attracted great numbers of gray
pelicans, which had the most wonderful mode of flight I have ever
seen in any bird. For hours at a time, with perfectly motionless
pinions, they skimmed the surface of the bay like living aeroplanes;
one wondered wherein lay their motor power and how they
managed to keep going. When they spied a school of mackerel, they
rose straight into the air with a great flapping of wings, then turned
their heads downward, folded their wings close to their bodies, and
dropped like a stone. Their great beaks cut the water, they went
under with a terrific splash, and immediately emerged with a fish in
the net-like membrane beneath their lower mandible.

When Whaling Is An Easy Job

Every Sunday, a boat's crew went fishing. We fished with hand

lines weighted with lead and having three or four hooks, baited at
first with bacon and later with pieces of fresh fish. I never had such
fine fishing. The fish bit as fast as we could throw in our lines, and
we were kept busy hauling them out of the water. We would fill a
whale boat almost to the gunwales in a few hours. With the return
of the first fishing expedition, the sailors had dreams of a feast, but
they were disappointed. The fish went to the captain's table or were
salted away in barrels for the cabin's future use. The sailors,
however, enjoyed the fun. Many of them kept lines constantly over
the brig's sides, catching skates, soles, and little sharks.
By the time we reached Turtle bay, it was no longer a secret that
we would get only a dollar for our year's voyage. As a result, a
feverish spirit of discontent began to manifest itself among those
forward and plans to run away became rife.
We were anchored about a half mile from shore, and after
looking over the situation, I made up my mind to try to escape.
Except for an officer and a boatsteerer who stood watch, all hands
were asleep below at night. Being a good swimmer, I planned to slip
over the bow in the darkness and swim ashore. Once on land, I
figured it would be an easy matter to cross the Sierras and reach a
Mexican settlement on the Gulf of California.
Possibly the officers got wind of the runaway plots brewing in the
forecastle, for Captain Winchester came forward one evening,
something he never had done before, and fell into gossipy talk with
the men.
"Have you noticed that pile of stones with a cross sticking in it on
the harbor head?" he asked in a casual sort of way.
Yes, we had all noticed it from the moment we dropped anchor,
and had wondered what it was.
"That," said the captain impressively, "is a grave. Whaling vessels
have been coming to Turtle bay for years to paint ship and overhaul.
Three sailors on a whaler several years ago thought this was a likely
place in which to escape. They managed to swim ashore at night
and struck into the hills. They expected to find farms and villages
back inland. They didn't know that the whole peninsula of Lower
California is a waterless desert from one end to the other. They had
Welcome to Our Bookstore - The Ultimate Destination for Book Lovers
Are you passionate about books and eager to explore new worlds of
knowledge? At our website, we offer a vast collection of books that
cater to every interest and age group. From classic literature to
specialized publications, self-help books, and children’s stories, we
have it all! Each book is a gateway to new adventures, helping you
expand your knowledge and nourish your soul
Experience Convenient and Enjoyable Book Shopping Our website is more
than just an online bookstore—it’s a bridge connecting readers to the
timeless values of culture and wisdom. With a sleek and user-friendly
interface and a smart search system, you can find your favorite books
quickly and easily. Enjoy special promotions, fast home delivery, and
a seamless shopping experience that saves you time and enhances your
love for reading.
Let us accompany you on the journey of exploring knowledge and
personal growth!

ebookgate.com