[ CHAPTER 1 ]
Diagnosing Plague Narratives
The Dog died on the Spot, and we left the Doctor endeavoring to recover him by the same Operation. JONATHAN SWIFT, Gulliverâs Travels
When the philosophers of the last age were first congregated into the Royal Society, great expectations were raised of the sudden progress of useful arts; the time was supposed to be near when engines should turn by a perpetual motion, and health be secured by the universal medicine. . . . But improvement is naturally slow. The society met and parted without any visible diminution of the miseries of life. SAMUEL JOHNSON, Idler 88 (1759)
This book stems from, and responds to, our impending crisis of faith in the ability of medical science to conquer epidemic disease. As I have noted above, I take this to be a Kuhnian as well as a spiritual crisis. In the last twenty years, the ânormal scienceâ governing our assumptions about disease (including the way historians write about disease) has been disrupted by worrisome anomalies outside the comfort zone of âproblem solving.â Once-firm distinctionsâas, fundamentally, between sickness and health, or between diseases of the first world and the third worldâseem increasingly fragile, as does our ability to demarcate an advancing âfrontierâ between the known and the unknown, between the natural realms under our control and those beyond the mandate of our rule. By ignoring a large blind spot in its own history as a disease exporter, the colonial West was once able to congratulate itself on pursuing the mission of bringing the benefits of modern medicine and sanitation to pestiferous regions of the globe. Now we find ourselves at a postcolonial moment whenâas H. G. Wells foresaw in The War of the Worldsâthe West lies open to devastating bioinvasions immune to (indeed, abetted by) advanced technology. The exhaustion of a dominant triumphalist paradigm thus brings us nearer a Hippocratic âcrisisâ in the case history of infectious disease, a skeptical epochĂ© in the face of our imperiled confidence in the knowledge whose promise of âvictoryâ seems less and less likely to be fulfilled.
In the case of âThe First Anniversary,â Donne offers a starting point both more and less skeptical than ours today about the state of our knowledge of disease: âAnd can there bee worse sicknesse, then to know / That we are never well, nor can be so?â1 To say that there is âno health,â that âwe are never well,â may be taken as a candid statement of the normative human condition in a premedical age. But to be sick is not the worst of it. According to Donne, there is no âworse sicknesseâ than to know that we are sick: not only to be knowledgeable about disease (to know what âPhysitians sayâ), or to have the experiential knowledge of our own sickness, or even to suffer the anxieties that attend such knowledge, but to know (as Bacon would also assert, but with a remedy) that knowledge itself is sick. In this light, sickness is itself symptomatic of a more profoundly diseased mode of being, the token of not only the individualâs illness, but the infirmity of all things. âWhen thou knowest this,â goes Donneâs refrain, âthou knowestâ the paltriness and corruption of our knowledge of the world, as well as of the world itself.
Yet such knowledge is, paradoxically, both deficient and perfect: deficient of any real power to explain disease, but perfect in the skeptical lesson it teaches us about our limited ability to know. The knowledge that we are ânever wellâ serves as a corrective to our arrogance; we realize that we can know nothing certain even about such mundane matters as, to echo Donneâs example, what makes our fingernails grow. Insofar as knowledge recognizes its own diseased state, however, its own inability to know truly, it truly knows the state of human disease. Individual sickness is, for Donne, both the reflection and the consequence of manâs original âruin,â when the body and mind fell together. The ruined body and the ruined mind are thus a perfect cognitive match. In the âessential joyâ of heaven, the âobjectâ of our knowledgeâthat is, the knowledge of Godâwill be âoneâ with the âwitâ by which we come to know that object: âit is both the object, and the witâ (âThe Second Anniversary,â 264, 1. 442). Ironically, amid the essential misery of a fallen, plague-ridden world, the same conditions of knowledge prevail. Our corrupt thinking is perfectly suited to thinking about the state of our own corruption, evident in the physical diseases to which we are prone. In this version of the docta ignorantia, disease(d) knowledge is that of a lack, of the absence of the âhealthâ we may find only when disease carries us off. In such a view, furthermore, disease must be seen not as one object of knowledge among many others, but as the fundamental subject, the subjective (and subjected) condition from which all other objects are seen, an epistemological as well as a biological infirmityâand at the same time, the source of a somber and unillusioned spiritual strength. It is in this mood that Montaigne approves the first lesson the Mexicans teach their children: âChild, you have come into the world to endure; endure, suffer, and keep quiet.â2 Insofar as the language of medicine and disease underwrites other Renaissance discourses, then plague and the fear of its recurrenceâthe miasmal cloud under which the Renaissance livesâshadow the experiential ground of that language. Except for the few remaining survivors of the generation of the âSpanish flu,â we cannot (yet) âknow,â as Donne and his generation did, what it was like (or will be like) to live and write in the shadow of a pandemic; but my hope in what follows is to reconstruct at least part of that knowledge.
As another document in the case history of the plague, this book positions itself at the point of unknowing what we thought we knew, or of not yet knowing how any argument made now will be read (or, perhaps, who will be around to read it) in the future. Under our present circumstances, it cannot speak above the fray from a secure vantage point; it must descend from the mountaintop to what Milton called the âsubjectedâ plain, in which we are as much subject to the history we survey as we can claim it as our subject. It must risk being speculative. It seeks to mark its spot by returning to another historical moment uncannily similar to our own, and with a sense of the âmiseries of lifeâ among the microbes closer to that of Swift and Johnson than to the optimism of Salk and Sabin. My purpose in this chapter is, first, to bracket the historical period of this study between the London plague epidemics of 1603 and 1665, and then to explore more fully the critical paths that may lead us back to the future.
Plague Times
The Black Death of the fourteenth century, long recognized as a calamity leading to âthe transformation of the West,â has been the subject of extensive critical investigation in all fields, from religious and economic history to demographics, the law, historical epidemiology, and the history of literature and art.3 In comparison, and as an object of specifically literary study, the impact of bubonic plague in early modern England has received less attention than it warrants, although the pestilence there and then was by every measure the most pernicious of Renaissance, as well as medieval, infectious diseasesâand its consequences were, arguably, no less profound.4 The epidemiological facts of the plague are well-known, and stark. Between 1348 and 1370, its first pandemic appearance in Britain (as in the rest of Europe) claimed at least a quarter and perhaps as much as two-thirds of the population, with the highest proportion of deaths in London. It would not be difficult to imagine Chaucerâs pilgrims near the end of the century as survivors on their way to the shrine of St. Thomas Becket, who âhem hath holpen, whan that they were seke.â5 Petrarchâs outcry in a letter to his brother, âOh happy people of the future, who have not known these miseries,â proved to be shortsighted.6 The Black Death was succeeded over timeâsuch is the natural history of epidemic diseaseâby aftershocks of varying intensity. On average, plague deaths tended to peak in London every fifteen or twenty years, the infection reasserting itself once its stock of potential victims had been replenished by births and immigration from the countryside with a new (non-immune) generation, and once the density of the cityâs population had again reached the necessary threshold for a new epidemic to take root.7 It became endemic in the sense that some plague deaths were recorded almost every year between major epidemics, while scattered outbreaks suggest that pockets of infected rats and their fleas could always be found. It appears, however, that new epidemics were imported from the Continent through such ports as Great Yarmouth and Hull. In its recurrences after the initial European pandemic of the fourteenth century, plague joined the ranks of typhusâthe âspotted feverâ with which it is sometimes confused in contemporary accountsâmalaria, syphilis, smallpox, dysentery, influenza, and other, unspecific (or now extinct) fevers and agues, such as the âsweating sickness,â that smoldered and periodically flared over the centuries.8
Yet among the maladies in this dismal catalogue of early modern suffering, the pestilence held a special terror. The âtertian agueâ (malaria) and the pox could be endured, their symptoms at least ameliorated. Syphilis, once it was domesticated in its milder form after its calamitous appearance the century before, provoked an endless number of bad jokes about âFrench crownsâ and missing noses, but even these stigmata could be worn with a certain smug pride as badges of amorous conquest. The âsmallâ pox could leave its survivors horribly disfigured, and few came through unmarked by its scars; but with (only) a 30 percent mortality rate among those who fell ill, the chances of survival were good. Like smallpox, with which the plague was often associated in Renaissance medical discourse, the pestilence was one of many diseases violent in their onset. Its staggering mortality rates tend to conceal the fact that not everyone fell illâwhether through the luck of inhabiting a relatively plague-free parish, or surviving quarantine, or fleeing, or (as was rare) having a natural immunity to the disease. Others fell ill and recovered, whether through the strength of their constitution or the luck of having contracted the infection in a milder form such as may appear in the latter stages of an epidemic. These fortunate ones could expect a long period of debility before regaining their strength. Compared with its companion diseases, however, plague was overwhelmingly and, for most of its victims, almost immediately fatal.
Plague may attack its victim in three distinct ways, the first two by way of the bite of an infected flea. In its bubonic form, it first invades the lymph nodes of the groin, throat, and armpits, producing excruciatingly painful swellingsâthe characteristic buboes. In its septicemic form, it kills more quickly by entering the bloodstream directly from the infected bite. As a pneumonic infection, it is transmitted from person to person by the breath, immediately overwhelming the lungs and leading to an even more drastic collapse. Among the malign family of gram-negative rod bacteria to which it belongs, Y. pestis replicates with alarming rapidity, producing a new generation every twenty minutes. After a three- to four-day period of incubation, its assault on the body is swift and overwhelming. The patient might linger for several agonizing days or even for a week in some cases, but (as the wits had it) a man might dine with his friends and sup with his ancestors. In one of his plague pamphlets, Thomas Dekker claims to have heard of a man about to send his wife to market who âfelt a pricking in his arme, neere the place where once he had a sore, and vpon this, plucking vp his sleeue, he called to his Wife to stay; there was no neede to fetch any thing for him from Market: for, see (quoth he) I am marked: and so shewing Gods Tokens, dyed in a few minutes after.â9 Such stories are common: an apparently healthy individual begins to reel and drops dead in the street, or a traveler retires in good spirits to his bedchamber at an inn, only to be found dead in the morning. Nowadays, plague is treatable with antibiotics if caught in time. Then, in whatever form it struck, mortality rates verged toward 60 percent or even higher. Recurrences always held a unique terror, as much for the thousands of victims they could quickly fell as for the ghastly suffering they brought to the individual.
For reasons still unclear, the major epidemics of the seventeenth century, both in England and on the Continent, were more devastating than any since the Black Death. England was spared the worst of the Italian epidemic of 1630â31, commemorated in Alessandro Manzoniâs great historical novel of 1827, I Promessi Sposi. Occasional spikes in plague deaths, as in 1637, were sufficient to close the theaters but did not develop into full-scale epidemics. But major outbreaks in 1563, 1593, 1603, and 1625âthe last two coinciding, ominously, with the death of the monarchâdecimated the London of Shakespeare, Donne, and Jonson. In 1603, 25,045 plague burials (out of a total of 31,861 burials) were recorded in the city and liberties. As Londonâs total population is estimated at 141,000 for that same year, the plague claimed one in five. In 1625 there were 26,350 plague burials out of a total urban population of 206,000.10 As one historian notes, a Londoner who, against the odds, succeeded in reaching old age at the time of the Restoration would have witnessed seven such visitations in his or her lifetime.11 The last and most severe English epidemic struck in 1665. Over that summer, the weekly bills of mortality in London ran into the hundreds and then into the thousandsâin all, a casualty list of more than 50,000 that dwarfed the number of fatalities on both sides of the Anglo-Dutch war in that same year. By mid-September, the bills reported a weekly total in Londonâs parishes of 7,165 dead, a figure that âall observers agreed to be a ridiculous underestimate.â12 This is the plague chronicled firsthand in Pepysâs diaries and reimagined fifty-seven years later in the docufictional account of Defoeâs Journal of the Plague Year. As a matter of luck or the protection of providence, everyone who lived to die of other causes between 1348 and the end of the seventeenth century was a plague survivorâjust as every American alive in the spring of 1919 could be counted as a survivor of the âSpanish flu,â which killed more than half a million people in the United States the previous fall and winter.
We have always known that the plague was there, reflected in the literary as well as the medical record, relentlessly taking its toll in England for more than three hundred years. After what proved to be its last cataclysmic gasp in 1665, it subsided as suddenly as it had appearedâagain, for a complex of reasons not completely understoodâretreating from the human population into its steady-state enzootic habitat of vermin and fleas....