Of all the modern epidemics, bubonic plague was considered mysterious longer than most other contagious diseases, and therefore more terrifying. Plague's victims died within days or hours of falling ill, writhing in pain and fever; governments spun into panic or denial; harsh measures were taken against stricken neighborhoods, including quarantine, placement of the ill in camps, and the burning of possessions. The course and eventual retreat of plague (and its uneven impact, depending on local environment) was not, as Echenberg painstakingly explains in this excellent book, simply due to the advancement of medical thought and practices, but rather to a combination of factors that included socioeconomic structures, political decisions, and local ecosystems. Until an obscure Australian physician in 1906 insisted on the systematic removal of rats as the sole effective measure in preventing the spread of plague, government and public health officials around the world targeted the inhabitants of their poorest neighborhoods—overwhelmingly plague's victims—oftentimes giving in to shockingly racist theories of the disease's spread.

Echenberg admirably fulfills the ambitious scope of this large, comparative study. He takes bubonic plague as a window into the dynamics of a range of societies, and illuminates the fascinating instances when medicine, health, politics, and social relations meet. Following the third bubonic plague pandemic from port to port, he examines how the disease played out medically, socially, and politically in no less than ten cities. This “follow the plague” approach offers several advantages. We learn of the global impact of the disease, we appreciate the effect of sociopolitical context in shaping each society's response to the disease, and we see the large role played by seemingly non-medical factors such as race and class in the history of medicine.

The book is structured to trace the plague's movement both chronologically and spatially as it traveled from Hong Kong in 1894, to Bombay, then Alexandria, Porto, Rio de Janeiro, Buenos Aires, Honolulu, San Francisco, Sydney, and Cape Town. These sections are preceded by an introduction that provides an overview of the mechanics of plague, and a brief history of germ theory, sanitation theory, treatment, and the development of a vaccine for plague. Echenberg ably demonstrates that each of the ten port cities had a distinct experience with the plague. In Alexandria, for instance, public health officials followed a syncretic approach to medicine and avoided segregation and stigmatization of victims. In Cape Town, by contrast, racial colonial medicine and the Boer war provided the context for the plague's exacerbation of racial segregation. In Buenos Aires, where plague threatened government's main goal of attracting European immigrants, it arrival was met by denial, while in Honolulu and San Francisco plague evoked near-hysteria and extreme anti-Asian discrimination. A final chapter on “Plague's Lessons” discusses the role the disease played in larger historical processes in each location, for example, the attraction of immigrants in Brazil and Argentina, or the mobilization of the black resistance movement in South Africa. He also discusses the public health implications of this pandemic and the outcomes for the history of medicine, such as the professional rivalries and eventual consensus around the disease's causes and treatments.

Echenberg packs an impressive amount of material into this book; the chapters are dense with information, but written in an engaging style. A sizable number of illustrations enhance the text. Stylistically, Echenberg made a choice to divide the chapters into very short sections, which this reader found somewhat distracting—though such a structure may have helped to tame all that material. In addition, there are minimal notes. Readers from the general audience will appreciate this, though scholars may wish for more extensive documentation. Plague Ports will be of great interest to historians of medicine and public health, and to comparative historians. Its accessible argument and rich historical material make it a good choice for undergraduate and graduate courses in the history of medicine and comparative history.