Beware contagious historical amnesia
Swine flu has been reported in 30 states and 20 countries, and face mask sales continue to soar. But this morning, health officials at the Centers for Disease Control remained “cautiously optimistic” that the swine flu virus is not as virulent as initially feared.
All of the hysteria about the disease got scholar of English Renaissance literature Ernest B. Gilman thinking. Perhaps, he argues, we need to protect ourselves against something potentially more damaging than the H1N1 flu strain: historical amnesia. After all, plagues, he notes, “have devastated the human race almost without intermission from the time that we began to cluster in large groups and mingle our own microorganism with those of our domesticated animals” and they show no signs of abating. In his forthcoming Plague Writing in Early Modern England, Gilman explores the sermons, medical tracts, pious exhortations, satirical pamphlets, and political commentary written in response to the three epidemics of bubonic plagues that devastated London in the seventeenth century. By revealing how people made sense of such catastrophe, he holds up a distant mirror to reflect our own condition in the age of AIDS, super viruses, multidrug resistant tuberculosis, and the hovering threat of a global flu pandemic. Here, he offers his thoughts on the current swine flu outbreak.
To the coughs, fevers, and other symptoms associated with the current outbreak of “swine flu” should be added one that most of us suffer from without knowing it: historical amnesia. We know that bird flu seems to be one of Asia’s most reliable annual exports to the west. We know that we live in the age of AIDS, and, that despite advances in treatment in the “developed” world, there are still more than 35 million people living with the infection mostly in sub-Saharan Africa. And thanks alike to apocalyptic headlines about exotic new diseases and to the Hollywood image factories that exploit our anxieties in such films as 28 Days Later and Doomsday (“Few could have foreseen the terror that the microorganism known as ‘Reaper’ would unleash upon the unsuspecting population”), we know about SARS, Ebola, Marburg, “flesh-eating” bacteria and other “superbugs,” not to mention MDR-TB and its more lethal variant X-TB.
The symptom of what we don’t know—or rather, what we are likely to forget—presents itself in our disbelief that such a thing could be happening now. All these “new” diseases, each scarier than the last, spring up in a way that may seem both unprecedented and extraordinary. Hadn’t we (“we” here means anyone over fifty) done our part as “Polio Pioneers” in the battle to conquer infectious disease once and for all? Were we not assured that with the development of vaccines that would prevent nearly all the once-inevitable childhood illnesses—and with an armory of antibiotic drugs to take care of those that managed to sneak past the defenses—even the most virulent epidemic diseases like cholera, smallpox, and bubonic plague were virtually extinct? In the glory days following the development first of sulfa, then of the first-generation drugs like isoniazid that actually cured tuberculosis, and then of the host of anti-bacterial and anti-viral medications to follow, it was easy for the most cautious epidemiologists and infectious disease specialists to buy into a narrative that begins with Lister and Pasteur, does homage to Salk and Sabin, and ends with heroic AIDS researchers like Drs. Anthony Fauci and Robert Gallo. The name of that story is “The Triumph of Modern Medicine.”
That narrative is now exposed as exhausted, and no one should be surprised even as we mourn its passing. The truth is that, to put it clearly, plagues have devastated the human race almost without intermission from the time that we began to cluster in large groups and mingle our own microorganism with those of our domesticated animals.
This insight has been popularized most recently by Jared Diamond in Guns, Germs, and Steel but it has been no secret to historians, especially those specializing in the history of Africa and the tropics. The notorious example of the “Black Death” of the fourteenth century is chronicled in every schoolbook. But it’s less well known that far from disappearing, the bubonic plague continued to ravage Western Europe for the next four centuries. In the England of Shakespeare and Milton, the period I study, witnessed three major pandemics—in 1603, 1625, and 1665. Each time, between a quarter and a third of the population of London was wiped out. In antiquity, a wave of epidemics—traveling along the Mediterranean trade routs, or in the company of returning legions—devastated the city of Rome. It is just as likely that Rome was already falling to germs before it finally fell to the Germans.
We have “forgotten” these things for two reasons, one psychological and the other a byproduct of the writing of history itself. School-book history, reflecting a long-standing set of narrative conventions, focuses on kings and revolutions and presidential elections, on the “rise” of this or that, or the “development” of something else. That more soldiers died of disease than in combat during the Civil War (indeed, in almost every war before World War II) seems coincidental, or accidental or at least far less exciting than a stirring account of the Battle of Gettysburg. History is smooth and consequential. Epidemics are interruptions in the order of things, and so often are left out of orderly accounts of events.
The psychological reason is more compelling. Those who have studied trauma—whether that of individuals involved in car crashes, of communities of flood victims and holocaust survivors, or of those who have lived through an epidemic—point to “forgetting” as a necessary part of the process of recovery. We do not speak of it; we push it into some far recess of being (perchance to revisit it in dreams, or re-live it the form of traumatic symptoms) and we “go on with our lives.” But the healing is balanced by a sense of shock when something like that happens again—and especially if it happens to us after so many years in which the story of medical progress was so encouraging.
At the moment, it’s sobering but necessary to keep the following hard facts in mind: First, just as epidemics have never been absent from human history for at least the last 100,000 years, there is no reason to believe that they will not recur in the future. The microbes were there before us, as the late Stephen J. Gould liked to point out, and they will likely be there long after we as a species are extinct. To be sure, diseases themselves go extinct: during the Renaissance there was an epidemic of something called ‘The Sweats’ whose recorded symptoms match those of no disease organism around today. But for the same reason, pathogens have the ability to modify themselves by natural selection, to adapt to new environments and new hosts, and to do so at a much more rapid rate than their large-bodied life companions (like us). For this reason, too, disease organisms will always be one step ahead any step we may take to head them off—remember, this year’s flu vaccine works against last year’s flu virus.
Responsible experts at the CDC will tell you, off the record, that we are almost surely headed for a Malthusian correction within the next century (possibly within the next generation, and maybe this week). The math is simple: population increases geometrically, but the food supply only arithmetically. It took the world until the year 2000 to produce a global population of six billion people. By 2050, the number is expected to top nine billion, even though the rate of increase has flattened out slightly. In the respected journal Population and Environment, David Price wrote in 1998 that “The impending crisis caused by unchecked consumption of nonrenewable resources and population growth is of such magnitude today that few are willing to accept its inevitability.” That prediction seems even more certain today. Famine and war (the other two traditional members of the population control squad) will surely continue to take their toll, especially in the “developing” world, but infectious disease—no respecter of treaties or frontiers—will likely finish the job of bringing the global population back into balance with the resources of food and energy needed to sustain it.