Epidemics and Ideas: Essays on the Historical Perception of Pestilence. - book reviews

Journal of Social History, Winter, 1993 by William H. McNeill

With one exception, the essays of this volume derive from a conference on 'Epidemics and Ideas' held at Oxford in 1989. Subsequent revision in the light of discussion at the conference and, mayhap, a firm editorial hand produced a remarkably cohesive and delightfully variegated book that brings medical and biological history into firm and fruitful contact with intellectual and social history.

As Paul Slack explains in the Preface, the essays explore two main themes. First, how "man-made images of pestilence have shaped responses to it," and thereby in moments of crisis give "expression to cultural and political values" already prevalent in the afflicted community. Second, by dint of judicious sampling, these essays show how images of pestilence and corresponding actions have varied from place to place and from time to time. A third theme that Slack points up--"the enormous importance of the 'government' element and the 'military' model which began in western Europe, and which became the medical orthodoxy and was carried from there to the rest of the world"--pervades all the essays that deal with colonial regimes of modern times; but the question of how and why it first arose in 14-15th century Italian cities and how it subsequently spread within Europe is only referred to in passing in the introduction itself. Here, obviously, lies another focus for research and reflection that Paul Slack is perhaps preparing to pursue.

The effect of reading the book through is to drive home the proposition that however real epidemic disease may be as a biological phenomenon, when humans are affected what happens is so thickly entangled in semiotics as to alter and deflect the merely biological phenomenon. Prudent historians, in other words, ought always to search out and consider prevalent ideas about epidemics and how to respond to them, weigh as best they can how this affected the records we have and the actual course of disease, recognizing that contemporary 'scientific' medicine is only one of a long succession of ways of understanding and coping with sudden outbreaks of lethal epidemic--and one which may not always be infallibly correct.

This latter point is tellingly illustrated by Rajnarayan Chandavarkar's analysis of the "superstitions of science" in his chapter on "Plague panic and epidemic politics in India, 1896-1914." He explains that when bubonic plague was first detected in Bombay in 1896 English officials knew that it was contagious and decided that compulsory isolation of those affected was the only way to check its spread. But they did not know that rats and fleas were the bearers of contagion, so, not surprisingly, even violently invasive efforts to detect infected individuals and send them off to isolation hospitals failed to check the epidemic. Instead, when it became apparent that the plague raged almost entirely among the poor, official efforts forcibly to impose medical police on the population were relaxed--partly because of the risks to public order that the initial effort at compulsory isolation had provoked, partly because personal fear of catching the disease abated among the English administrators, and partly because their scientific public health measures did not seem to be working as expected.

Other chapters have comparable stories of how diverse societies coped with disease emergencies in accordance with prevailing ideas, or, when established ideas and institutions fell conspicuously short, how prophets and other self-appointed reformers arose to proclaim a new path. From this point of view, Edwin Chadwick, the English sanitary reformer in the 1840s, and an array of African prophets of the 1850s to 1890s appear as brothers under the skin, since each in his own way responded to epidemic emergency by propagating new, radically simple answers and successfully persuaded significant numbers of their fellows to act accordingly--whether it meant constucting flow-through water supply systems, as in England, or killing cattle, as among the Xhosa in Africa--to cite the two most extraordinary instances of new behavior. Initial response to AIDS in Great Britain between 1981 and 1986, as analyzed by Virginia Berridge in the last chapter of the book, also exhibited a bureaucratically muffled instance of how a disease that did not fit established expectations elevated new men "without much previous experience" into a "position of direct influence".

Other arresting and surprising suggestions abound in the pages of this book. My favorite, perhaps, is Peregrine Horden's artful argument to the effect that an epidemic of dragons in Merovingian Gaul, as reported in saints' lives from the period, records the prevalence of malaria. His arabesque learning and lively imagination allow him to suggest that saints celebrated for overcoming these "dragons of disease" may have been engaged in such humdrum activities as organizing the draining and ditching of malarial landscapes! Comparing it with Terence Ranger's chapter "Plagues of beasts and men: prophetic responses to epidemic in eastern and southern Africa," to which I have already referred, shows how much radically different societies have in common when trying to invent appropriate ways of coping with lethal or disabling epidemic.