Christopher Hamlin, More Than Hot: A Short History of Fever

Christopher Hamlin, More Than Hot: A Short History of Fever (Baltimore: Johns Hopkins University Press 2014). 400 pp, 11 halftones, 9 line drawings. £16.50 Pb, EPub, PDF. ISBN: 978-1-421-41502-4.

Christopher Hamlin’s comprehensive work seeks to address the common experience of fever, moving from its role in classical medicine, to post-modern conceptions of the affliction.  With sweeping breadth, More Than Hot offers an interdisciplinary history of the world through the lens of febrility.  Hamlin’s study proves to be a reflection on how the meanings of fever - as a term and as a cultural construct - continue to shift, affecting not only individual and public health, but also the construction of identity.
Hamlin begins his study - part of the Johns Hopkins Biography of Disease series - by reminding us of the obvious: disease has always been a part of culture, with pathologies long predating formal patient narratives.  Hamlin, however, is aware that “most older descriptions and terminology do not track easily onto twenty-first century categories and understandings,” and seeks to collate various historical trends surrounding understandings of fever (vii).  A simple idea in theory, Hamlin’s work draws together the fields of science, medicine, philosophy, and popular culture, doing so with a sense of command and coherence.  More Than Hot: A Short History of Fever addresses issues of expression and classification, and the constantly evolving social, cultural, and even political significance of fever.  By way of establishing a foundation for his project, Hamlin cites the eighteenth-century Dutch-Austrian physician, Gerard van Swieten, who claimed that “‘[n]o person can live without fever’” (1).  Through his detailed historical narrative, Hamlin - who is well versed in writing on matters related to the history of public health and environmental science - demonstrates the truth apparent in van Swieten’s assertion.

More Than Hot is divided into four parts, all of which I will touch upon briefly.  The first begins by addressing the pervasiveness of fever, and the difficulty early medical writers faced in establishing an adequate conceptual lexis with which to define pyretic states.  Hamlin notes that the problems surrounding the construction of such a taxonomical register were “biological as well as linguistic and social” (9). In this way, it is the philosophies of fever that are first touched upon, with a focus on those espoused by Hippocrates and Galen, and adopted by the medical traditions of China, South Asia, the Mediterranean, and Europe.  Hamlin is careful not to draw distinct lines between cultures and historical periods, but rather works to paint a more comprehensive and inclusive picture of fever.  While it was not until the nineteenth century, and the rise of microbiology, that the ontological view of diseases became normalized, through outlining the importance of “the battle of the books,” or the movement towards the conspicuously literary dissemination of Galen’s work, Hamlin underscores the manner in which ideas surrounding fever were perpetuated and reinvented from the classical period onwards.

Taking as its basis the nineteenth-century conception of fever, Part II of Hamlin’s biography of disease explores the social role of febrility, as well as the ways in which the affliction could be constructed or reinterpreted by society.  Through looking at the condition in relation to communities and selves, More Than Hot demonstrates how imperialism influenced attitudes surrounding fever, establishing it as a key element of conquest, and in establishing global health expectations.  In this respect, the nineteenth century can be seen as a sort of linchpin in the history of conceptualizing febrile affections.  Hamlin notes that by the early nineteenth century, “fever had become an element of identity.  Certain fevers were being associated with certain groups—prisoners, soldiers, women, Irish beggars, indigenous peoples,” et cetera (90).  It is argued that through such divisions, fever rendered these groups problematic in various ways.  Some came to pose the threat of contagion, while others became representative of perceived nervous sensitivities, occupational risks, or “the pathologies of a homeland” (90).  Because fever affected all humans, its varied forms and characteristics provided modes of differentiation.  In a related argument, Hamlin seeks to shed light on the interdisciplinary nature of such interpretations or distinctions.  He notes that increasingly, fevers became features of narrative, and that novelists, philosophers, and doctors alike sought to discern the lessons of fever.  Hamlin notes that, during the Victorian period, febrile delirium was a recognized form of alienation from the self, and was characterized as being induced by contagion, exotic places, activities, and individual experience, all of which became frequently used literary tropes.

Part III centers on the modernization of fever, and uses this focus to explore its plurality, distinctiveness, and its redefinition to refer specifically to internal temperatures exceeding 98.6°F.  While Galen had deemed this a “preternatural” heat, his successors came to see it as a transitory aspect of fevers (166). Hamlin takes this as his point of departure to explore the facts of fever, and what happens when cultures no longer view bile, heart, blood, vessels, and nerves as fever’s substratum, and heat, tremors, and mental alienation as its defining clinical features.  Moving on from the nineteenth century, and the rise of bacteriology and epidemiology, More Than Hot comes to consider the importance of “number and nurses” in the history of fever, namely the golden age of specificity that the Victorians initiated, which allowed their twentieth-century counterparts to set about naming and treating fevers in new ways.  Hamlin claims that as a result, pyretic manifestations were “becoming a general physiological process, perhaps also an accident of evolution, that manifested as heat” (252).

In “Fever, Modern and Post-Modern,” Part IV of Hamlin’s book, the argument shifts towards representations of fever in popular culture, and its extensions of the condition’s definitions.  Hamlin shows that febrility is increasingly used a metaphor, as illustrated by the idea of an “enfevered Earth” when discussing global warming, for example.  Pyretic states may now infrequently become life threatening, or indicative of plagues and other epidemics, but that does not mean that the term has vanished from common usage as it deviates from the purely biomedical.  Hamlin shows that just as it has been since the time of Hippocrates, “fever” is an ever-evolving term.  Hamlin concludes that “to expect fever to be a stable concept seems naïve” (312), offering, as compelling takeaways to consider, the tenets of classical medicine, that fever is an important site for accounting and acknowledging human vulnerability, and that it remains a gateway to “otherness” (which can, Hamlin argues, also be viewed as a source of divisiveness in modern discourses and culture surrounding febrile afflictions), although Hamlin cautions: “to bring meanings to fever seems quite right, but it is best to be careful in deciding which ones” (312).  Importantly, this final line does not seek to oversimplify the history of fever, but rather, to acknowledge its complex and evolving nature.

When considering the movement through the centuries, and, indeed, millennia, in regarding pyretic states as something both internal and external, causal and proximal - as a product of both environmental and human disorder - More Than Hot manages to keep a hold of both strands of this investigation.  In fact, Hamlin manages the remarkable achievement of constructing a coherent historical narrative of an affliction as old as time, whose definitions and boundaries are remarkably fluid.  The book delivers what the title promises as Hamlin moves easily from Hippocrates to Sydenham, from zombies to post-apocalyptic contagion, with the result being a remarkably thorough, well-managed history of fever.

Kalika Sands, University of Oxford