Historians of epidemic diseases continue to add new dimensions to our understanding of the past. In A Modern Contagion, Amir A. Afkhami effectively and efficiently contributes to this historiographical development through an examination of the role of disease (particularly cholera) in the emergence and reception of modernity in Iran. Afkhami draws upon multiple methodologies to provide a fresh and nuanced study of the late Qajar period in Iranian history.

Afkhami's overarching argument is that the European imperial response to outbreaks of epidemic diseases in and around Iran, which included the posting of British and Russian consular officials and medical professionals in Iran and the construction of British and Russian-managed quarantines and sanitation posts on Iranian soil, contributed as much if not more than geo-political or economic considerations to the erosion of Iranian territorial sovereignty in the mid-to-late-19th century. An important corollary to this line of argumentation is that this form of “sanitary imperialism” not only failed to prevent the outbreak and spread of disease in Iran but, by reducing the Iranian state's control over its borders and opening Iran to more foreign trade, made Iran “increasingly vulnerable to epidemics from abroad” (p. 105).

Operating across and moving seamlessly among national, transnational, and global contexts, Afkhami emphasizes the influence and impact of “bio-medical modernity” on Iranian politics and society. The international frame is particularly strong and Afkhami does well to remind us of the centrality of international sanitary conferences in the broader story of international relations in the 19th century. Highlighting the Russian Empire's sustained involvement in Iranian affairs across the 19th and into the early 20th century, Afkhami's analysis of the nexus between disease, diplomacy, and territorial sovereignty in Irano–Russian relations in the modern period is ground breaking.

Afkhami acknowledges the difficulties faced by Western-based scholars in accessing archives in Iran and successfully corrects for a necessarily Eurocentric (primarily British and French) archival source base by reading deeply in and drawing heavily upon published Arabic and Persian-language primary sources and the broad and ever-growing literature of secondary sources on disease in history. However, given the general themes of this book (i.e., Islam and disease, the connections between the spread of epidemic diseases and commercial relations) and the specific context and time period addressed (i.e., Western imperial intervention in the Middle East in the 19th century) a few important English-language sources are overlooked, including: Michael Dols’ The Black Death in the Middle East, (Princeton, NJ: Princeton University Press, 1977); Justin Stearns’ Infectious Ideas: Contagion and Pre-Modern Islamic and Christian Thought in the Western Mediterranean (Baltimore, MD: Johns Hopkins University Press, 2011), Mark Harrison's Contagion: How Commerce Has Spread Disease (New Haven, CT: Yale University Press, 2012) and the work of Christopher Michael Low, particularly his 2008 article in this journal, “Empire and the Hajj: Pilgrims, Plagues, and Pan-Islam under British Surveillance, 1865–1908.”

This book is accessible, easy to read, and a jargon-free model of clarity. Well-distilled conclusions end every chapter, testifying to Afkhami's firm grip on his subject material. The inclusion of maps and mortality charts help to center the account and assist the reader in appreciating the spatiality of epidemic diseases in Iran. Particularly helpful in this regard are the maps charting the temporal and directional flows of the cholera epidemics that repeatedly struck Iran across the 19th century. Afkhami provides comprehensive data on fatalities (that totaled up to 700 per day in Tehran and 1,000 per day in Shiraz at the height of several cholera epidemics) and a series of four appendices with translated Iranian government decrees and regulations on public health and sanitation interventions (from 1879, 1897, 1911, and 1914) that will certainly prove useful to scholars interested in looking comparatively at state-generated anti-disease initiatives and state–society relations in the late 19th and early 20th centuries. Images of the architecture and landscape design of the British quarantine station in Bandar Abbas were of particular interest to this reviewer.

There are a few discordant notes in this book. First, the reframing of the late Qajar period as “Iran's Age of Cholera” (as indicated in the book's title) is misleading and undersells the range of disease-based analyses provided in the text. While cholera receives most of the attention, Afkhami extends his narrative frame into discussions on plague, malaria, smallpox, “the Spanish flu,” anthrax, and tuberculosis. Additionally, in navigating the tricky interstice of environmental and national(ist) history Afkhami hesitantly oscillates between a more causal and/or determinist interpretation of the role of epidemic diseases in history and one that more conservatively assesses the impact of disease on economic, social, and political developments in the past. Second, the inclusion of an albeit excellent epilogue on public-health issues and interventions in the post-1979 Islamic Republic of Iran comes across as a bit of an outlier relative to the main body of the text. Third, given his experience as a public health practitioner, one wishes that Afkhami would have engaged at some point in a more detailed discussion of the etiology and biology of the cholera bacteria. The ability to “translate” science for the lay scholars among us is an increasingly essential skill as the hard sciences, social sciences, and humanities continue to coalesce around environmental and disease-focused stories and studies. And finally, while Afkhami is careful to acknowledge the role of the Shiʿi ʿulamaʾ in both resisting imperialist encroachments on Iranian national sovereignty in the late 19th and early 20th centuries and ensuring administrative continuity and social stability during disease-induced political crises, more often than not the tendency in this text is to reinforce the Western/secular/modern/progressive versus Eastern/fatalist/traditional/backward binary in the Western imperial encounter with the Islamic World in the modern period. This is an historiographical paradigm that scholars of Islamic Modernism have effectively problematized over the past few decades. While Afkhami does note the sometime support of the Shiʿi ʿulamaʾ for the introduction of innovative Western European hygiene and sanitation measures in Iran, a fuller and more balanced discussion of the position and role of the Shiʿi ʿulamaʾ in the biomedical modernization process in Iran would have expanded the historiographical scope of this book.

More than merely “filling a gap” in our understanding of the history of Modern Iran, Amir Afkhami in A Modern Contagion deftly moves between national and international contexts and expertly blends the analytical tools of public health and history to develop a fuller and more in-depth picture of the economic, political, and social history of late-19th-century Iran. This is, given the amount and weight of entrenched scholarship on this important period in Iranian history, a definite accomplishment. For this reason, in addition to speaking to scholars of Middle Eastern studies, imperialism, international relations, and public health, this book is recommended for anyone, whether they be established academics, graduate students, or the general reader, who is interested in increasing their knowledge of the modern history of Iran.