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DREAD
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DREAD
HOW FEAR AND FANTASY
HAVE FUELED EPIDEMICS FROM THE
BLACK DEATH TO AVIAN FLU
PHILIP ALCABES
PublicAffairs
New York
1586488093-text_Layout 1 1/29/10 1:24 PM Page iv
To my father
The lines from Thucydides’ Histories, Book 2, originally translated by P. J. Rhodes, as modified
by G. E. R. Lloyd in The Grip of Disease: Studies in the Greek Imagination (Oxford, 2003), appear
here with permission of Oxford University Press and Aris & Phillips Publications.
Portions of chapter 6 originally appeared in different form in The American Scholar (2006).
No part of this book may be reproduced in any manner whatsoever without written
permission except in the case of brief quotations embodied in critical articles and reviews. For
information, address PublicAffairs, 250 West 57th Street, Suite 1321, New York, NY 10107.
PublicAffairs books are available at special discounts for bulk purchases in the U.S. by
corporations, institutions, and other organizations. For more information, please contact
the Special Markets Department at the Perseus Books Group, 2300 Chestnut Street,
Suite 200, Philadelphia, PA 19103, call (800) 810-4145, extension. 5000, or e-mail
special.markets@perseusbooks.com.
Alcabes, Philip.
Dread : how fear and fantasy have fueled epidemics from the black death to avian flu /
Philip Alcabes. — 1st ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-58648-618-1 (alk. paper)
1. Epidemics—History. 2. Communicable diseases—History. 3. Epidemics—
Psychological aspects. 4. Epidemics—Social aspects. 5. Nosophobia. I. Title.
[DNLM: 1. Disease Outbreaks—history. 2. Fear—psychology. 3. Anxiety—
psychology. 4. Communicable Disease Control. 5. Communicable Diseases—history. 6.
Health Behavior. WA 11.1 A346d 2009]
RA649.A43 2009
614.4—dc22 2009000248
Paperback ISBN 978-1-58648-809-3
10 9 8 7 6 5 4 3 2 1
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CONTENTS
Acknowledgments 231
Notes 235
Selected Bibliography 289
Index 297
v
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INTRODUCTION TO
THE PAPERBACK EDITION
vii
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A big threat—or just big hype? In the fall of 2009, no one could
ignore the swine flu. It was in the headlines, a feature of television talk
shows, the subject of conferences and official press releases, the theme
for posters reminding us to wash our hands, the reason why some
people donned masks on the subway and others refused to shake hands,
the trigger for new policies in schools and colleges and, of course, the
billions of taxpayer dollars, euros, and yen spent on vaccines.
Swine flu, or “H1N1 2009,” made the premise of this book seem
prophetic. As an epidemiologist and compassionate observer, it’s im-
possible for me to be happy about a nasty disease outbreak responsi-
ble for thousands of deaths. As an author, though, it’s gratifying that
the outbreak, and its attendant debates, so quickly proved the book’s
point: that a society’s epidemic narrative reflects its own anxieties
and dreads—not necessarily real harm or ensuing suffering.
From the beginning, both media and health officials depicted the
flu outbreak of 2009 as a crisis. American newsmakers and media in
particular had a decided influence on international news.
The crisis began in April 2009, when brief reports of an unusual
flu strain in California and Texas were followed by a summary article
in the New York Times that effectively set the stage for pandemic
worry. The first major news coverage, the Times’s article “Unusual
Strain of Swine Flu Is Found in People in 2 States,” made several
points that were crucial to shaping the pandemic narrative. The arti-
cle hinted that a new strain of flu was afoot, that it came from Mex-
ico, and that it had some of the characteristics of past pandemic
strains. Although no link had been established between seven cases
of flu in California and Texas and an outbreak of adult respiratory ill-
ness in Mexico, the article reported that Mexican authorities had
noted a high death rate there—essentially creating an association in
people’s minds. It reported that the new flu was made up of genetic
elements “from North American swine, bird, and human flu strains
as well as one from Eurasian swine.” And it pointed out that all the
new cases were under the age of 55, lower than the usual age range
for serious flu cases.
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The next day’s Times story, “Fighting Deadly Flu, Mexico Shuts
Schools,” explicitly linked the Mexican outbreak to the disastrous
flu outbreak of 1918, which killed tens of millions of people world-
wide in a matter of months. Measured in deaths per month, the
Spanish Flu has never been equaled. When the Times piece pointed
out that the young age of the 2009 flu victims was worrisome be-
cause “pandemic flus—like the 1918 Spanish Flu . . . —often strike
young, healthy people the hardest,” alarm bells went off.
In the first two days of reporting, America’s premier newspaper
had established the grammar for the story of a new pandemic: There
was a new strain of influenza. It came from animals. It was causing a
big outbreak in a country that, significantly for Americans, is not
only poor but has long been suspected of exporting noxious influ-
ences northward—including drugs, the Spanish language, and un-
documented immigrants. Its pathologic pattern was similar to that of
the 1918 flu (and so was its origin in animals). As in 1918, schools
were being closed. The story of global threat was being written, and
read, widely.
As is so often true, the epidemic is a story of crisis. And a pandemic
becomes a pandemic as the crisis story is recounted by the media. The
New York Times’s flu coverage jumped in 2003. That year, the paper
ran fifty articles on flu, mostly focusing on the threat posed by H5N1,
the avian flu. In the following year, while the government in Wash-
ington shifted from bioterrorism preparedness to flu-pandemic pre-
paredness (the White House had kicked off the bioterrorism
preparedness fad with Project Bioshield in 2002, but issued a new pan-
demic plan focusing on flu in August 2004), flu coverage in the Times
climbed to over ninety articles per year, where it remained for some
time. The Washington Post showed a similar pattern, with flu coverage
nearly tripling between 2002 and 2004 and continuing to rise there-
after. A Times reader would have encountered an article on flu roughly
every six weeks before 1996; by 2006 she would see one every four
days. A Post reader would have seen flu mentioned in the paper’s A
section about once a week in 2002, but nearly once per day by 2006.
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But don’t blame the news media alone. They package the news
on diseases as it is created by health officials, scientists, funding agen-
cies, regulatory agencies, and others. It’s better to look at the account
of swine-flu-as-global-threat as the Preparedness Crusade—a rhetori-
cal campaign launched by a virtual industry whose product is health
threats. Public health officials, agencies and foundations that provide
monies for research, scientific and health researchers, industries that
make products supposedly designed to protect against threats, and,
yes, the media, all benefit when the public is alarmed.
For government agencies, an aim of the preparedness rhetoric has
been to play on people’s ingrained sense of vulnerability in the mod-
ern world, and on putatively highlighted fears after the September 11
disasters. But this unease hardly began in 2001; it is a most unmodern
feeling that can be traced back at least to the Middle Ages. It is the
very reason why Christians of the Black Death era thought God had
sent plague to punish impiousness, and why when cholera arrived in
1848 Americans held a national fast day to expiate what many saw as
the faithless imprudence of a restless nation. The worry that our social
arrangements invite disaster in ways that our forebears’ social arrange-
ments did not—the sense that the good old days were safer and hap-
pier—always crystallizes when there is a threat of epidemic illness. We
suspect we are receiving our just deserts. Those who want our affec-
tion, our dollars, or our votes have always been able to capitalize on
that anxiety. The preparedness rhetoric, as promoted by the White
House but endorsed by the industries of public health and medicine in
America and, increasingly, abroad, evokes a frightening future. It as-
serts that only scientists and health officials can read its auguries cor-
rectly. And it demands that the public allow officials to state what is
going to go wrong and what must be done to prevent that.
Forecasting a frightening future that’s manageable only by state
officials is not purely an American habit. Although it was the direc-
tor of the U.S. Centers for Disease Control and Prevention who
forthrightly called swine flu “a major problem [that] requires a major
response,” he was not alone. The Chinese government invoked spe-
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rate of spread, and so forth. But with flu, expectations of future harm,
not facts, drive the discussion. It is as if, once a future has been fore-
cast, it is real and should be treated as real or, as many like to say,
“scientific.” The facts of infection rate, vaccine effectiveness, and so
forth, appear to validate the forecast—except when the facts debunk
the forecast and de-claw the threat, in which case they’re ignored.
As of the end of 2009, about 12,000 people had died from con-
firmed swine flu infection worldwide. Even accounting for up to
36,000 additional deaths from other causes triggered by swine flu, the
2009 flu killed fewer people in the eight months after the outbreak
began than diarrheal illnesses do in the world’s poor countries in any
single month. Malaria, TB, and AIDS are likewise far deadlier than
swine flu: together they are responsible for 5 million deaths a year,
almost all of them in impoverished nations. Swine flu’s toll in 2009
was 100 times less.
But the clemency of flu by comparison to diarrhea, malaria, TB, or
AIDS was not a fact deemed relevant in the response to swine flu.
Nor was the fact that, in clinical trials, the best flu vaccines protect
only about 70 percent of recipients against infection with influenza
virus. Or that of the 147 children who died of flu in the U.S. between
September ’08 and September ’09, 70 percent also had bacterial infec-
tions—suggesting that the problem might not have been flu per se but
a failure of medical care to offer appropriate antibiotic treatment to
those with severe cases of flu. The fact that antiviral medications like
oseltamivir (Tamiflu) have never been shown to reduce the spread of
influenza virus was not part of the discussion about distributing the
drug; nor was the fact that the U.S. president had successfully pressed
for authorization to purchase $1.7 billion worth of Tamiflu in 2005, or
that the man who was U.S. secretary of defense at the time had held
stock in a company (Gilead Sciences, which had held the original
oseltamivir patent) that profited from Tamiflu sales, or that the ap-
pearance of swine flu in 2009 upped the purchase of Tamiflu world-
wide to 200 million doses, representing additional profit for
manufacturer Roche. The facts deemed relevant were the ones that
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supported the preparedness campaign and its parent industry, the one
that creates health scares. As this book explains, this pattern is now
common with health officials: calling an event an epidemic frees
them from the burden of producing facts.
Only a short time after the swine flu outbreak, debate arose over
the appropriation of the terms “epidemic” and “pandemic.” On June
11, 2009, the World Health Organization raised its so-called pandemic
threat indicator to 6, the highest possible level. “Pandemic,” con-
cocted out of “epidemic,” indicated an outbreak that affects the whole
world, and WHO meant it that way. But the agency took flak from
public health professionals who decried the delay in declaring a pan-
demic. At the same time, the agency was attacked by other health pro-
fessionals who feared that WHO’s proposal that an outbreak’s severity
(and not just its extent) should determine whether it was a global
threat would dilute what they thought (erroneously) to be the purely
scientific meaning of the term pandemic. Another group of commen-
tators criticized WHO for creating such a hubbub over an outbreak
that, after three months, was responsible for fewer deaths worldwide
than occur in a single weekend on roads in the EU countries.
The debate over whether swine flu should be considered a pan-
demic, and the more circumscribed debates over whether schools
should be closed, travel delayed, Tamiflu stockpiled, etcetera, tended
to obscure some of the more compelling questions about flu and epi-
demics in general.
How much does the sense that swine flu is a global threat stem
from its initial recognition in America, for instance? If there had
been no flu fatalities in the U.S., would there have been so much de-
mand for a “response” to this pandemic threat? What makes news in
the United States, especially when the news is conveyed by the New
York Times, Washington Post, or a few other core sources, is especially
likely to be carried in non-U.S. news media.
Would people have demanded that WHO raise its pandemic
threat barometer to the highest level if their sense of foreboding had
not been whetted by years of the pandemic preparedness campaign,
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with its high price, high profile, and repeated reminders of the hor-
rors of the 1918 flu? When the alleged bioterrorism threat turned out
to be chimerical, the preparedness campaign that had manipulated
America’s public into supporting endless war shifted to flu. That
gave it a more global appeal. But it was still based on the idea of secu-
rity. How would people have responded to the flu problem if public
health, rather than preparedness, had been our watchword? Might
we have decided that swine flu was a lesser concern than, say, auto-
mobile fatalities—a source of unremitting harm (over 30,000 Ameri-
cans die in vehicle accidents each year, far more than swine flu
claimed in 2009), which, unlike influenza, could really be abated per-
manently with public policy adjustments regarding public transporta-
tion, gasoline prices, urban planning, food industry regulation, and so
on? Might we have decided that other global problems that don’t
affect our own society as much—childhood diarrhea, malaria, or
AIDS, for instance—really deserved more attention than swine flu?
Had there been no campaign to create flu fears, this mild out-
break surely would have carried less meaning. But “epidemic” is a
loaded term. The discussions about an epidemic—and there have
been many, with swine flu—are not really about the facts of illness or
death; they are about the competition to impart meaning and con-
vince others that one preferred meaning is correct.
In that sense, the swine flu experience brings to life the central
message of this book: throughout history, the facts of harm have of-
ten been distant from the perceptions of threat, and the struggle to
close the gap has given rise to assertions about risk. When we heed
warnings about the supposed need to invest in more germ-fighting
technology, when we buy the rhetoric that an epidemic illness must
be confronted because of its alleged capacity to damage future gen-
erations, when we ignore the self-evident distress of others in order
to attend to risk in our own people, or when we agree to give up lib-
erties in exchange for protection from risk, we are acting in the
modern version of an old drama, a story in which fears and anxieties
are transformed into meaning—into the epidemic.
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Introduction
1
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2 D RE A D
4 D RE A D
The deeper answer, and the one this book explores, has to do with
anxieties that go beyond the normal dread of death or destitution. To
judge by our response to epidemics that are less sudden or cata-
strophic than the Black Death, we fear much more besides: strangers,
flying things, modern technology, female sexual desire, racial differ-
ence, parenting, the food we eat, and so on. These concerns, beyond
the simple dread of death, are part of our makeup. They identify us as
citizens of the society we live in and distinguish our world from the
ancient world of demons. The way we have responded to epidemics
like polio, AIDS, and SARS, and the way we are currently respond-
ing to obesity, autism, and addiction, reveal that we bring fears to the
prospect of any sort of epidemic, deadly or not.
This book looks at epidemics throughout Western history, going
back to the Greeks and Romans, moving up through the Black
Death and the development of epidemiology in the nineteenth cen-
tury, and continuing to the present day. It looks at epidemics from
three different perspectives. First, an epidemic registers as a physical
event: there is a microbial disturbance in an ecosystem with accom-
panying shifts in the well-being of different human populations. An
epidemic also plays a role in social crisis: the illness and death that
spread widely act as destabilizers, disrupting the organization of
classes, groups, and clans that make up the society we know. Finally,
an epidemic has an identity as a narrative that knits its other aspects
together: we tell ourselves stories about ourselves, accounts that
make sense of what we see happening as well as what we fear (and
hope) will happen. These three aspects of the epidemic can’t be di-
vorced from one another: all significant spread of illness also creates
a social phenomenon; every social crisis moves us to make sense of it;
each revision of the story of our society alters the way we study dis-
ease (and even how we define illness) and changes the pitch of social
change. To read the history of epidemics is to follow a long story of
the fears that go beyond the dread of death, the anxieties that make
us who we are.
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6 D RE A D
Chapter 1
7
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8 DREAD
10 DREAD
k
“Epidemic” has always been a troubled term, shifting with human-
kind’s fears. The history of our encounters with epidemic disease is a
story of people making sense of the extraordinary in terms of the or-
dinary. Some themes have been constant through recorded history:
from malady in the ancient Middle Eastern land of Chaldea to the
biblical plagues in Egypt to postal anthrax in the United States,
the way we have thought about epidemics has involved ideas about
place and disaster, two more-or-less concrete notions about the natu-
ral world, and a more elusive understanding of disease. For the past
2,500 years our understanding of disease has evolved with the state of
knowledge about how we are affected by nature, and it has borne a
changing burden of anxieties about bodies, souls, and the way we live
in the world we have made. Prominently, ancient suspicions of con-
tamination, divine punishment, and moral correction have perme-
ated humanity’s awareness of disease and continue to influence our
grasp of the epidemic.
The modern use of the word “epidemic” to describe diseases was
introduced by Hippocrates, the early Greek medical writer, who lived
around 400 BC. In Part Three of his canonical work, On Airs, Waters,
and Places, Hippocrates drew the first distinction between epidemic
and endemic conditions:
sons. And when they pass their fiftieth year, defluxions superven-
ing from the brain, render them paralytic when exposed suddenly
to strokes of the sun, or to cold. These diseases are endemic to
them, and, moreover, if any epidemic disease connected with the
change of the seasons, prevail, they are also liable to it.
12 D RE A D
k
In Homer’s day, pestilence was understood as an act of the gods. The
disease that decimates the Achaean army at the beginning of The Il-
iad is ignited by a flaming arrow shot by the god Apollo (the son of
Jove by Leto), who is angry with the Achaean leader, Agamémnon,
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for his treatment of the priest Khrysês. Attributing to the gods the
power to strike people ill or dead in retribution for improper acts,
the ancient Greeks tried to make sense of illness and gave disease a
moral meaning as well as a physical one.
The idea of pestilence as punishment lost its power with the
Greeks, to be revived much later with Christianity. But even before
Hippocrates’ work was widely known, Greeks were moving away
from the assumption that the gods were angry when pestilence
struck. The historian Thucydides, roughly a contemporary of Hip-
pocrates, saw no particular godly reprisal in the Plague of Athens of
427 BC. Writing circa 410 BC, he says:
[The Peloponnesians and their allies] had not yet spent many
days in Attica when the disease [nosos] first struck the Atheni-
ans. It is said to have broken out previously in many other
places, in the region of Lemnos and elsewhere, but there was no
previous record of so great a pestilence [loimos] and destruction
of human life.
The plague is said to have come first of all from Ethiopia beyond
Egypt; and from there it fell on Egypt and Libya and on much of
the King’s land. It struck the city of Athens suddenly. People in
[the Athenian port city of] Piraeus caught it first, and so, since
there were not yet any fountains there, they actually alleged
that the Peloponnesians had put poison in the wells.
14 D RE A D
the old Homeric certainties that the gods must be behind an ex-
traordinary event. But the ordinary provided no clues as to why such
a catastrophe would occur.
Pestilence remained a malleable term. Sometime before 29 BC, in
the Georgics, Virgil invokes the word “pestilence” (pestis in Latin)
when he reports on an outbreak of disease among cattle, pecudum
pestes, in the Alpine regions north of the Adriatic. An agrarian trea-
tise rather than a work of history, the Georgics had a practical out-
look: to describe bad things that could happen to livestock if they
were not managed properly. Virgil’s text explicitly states that pesti-
lence can be wholesale: “Not single victims do diseases seize, but a
whole summer’s fold in one stroke.” But he also used “pestilence”
metaphorically to indicate a scourge, a bothersome thing—like the
adder he calls pestis acerba boum, the “sore plague” of cattle, capable
of gliding under the straw that shelters the herd and harming cows
with its venom. Pestis could point to something dire without imply-
ing what we would call an epidemic.
The distinction between “pestilence” and “plague” becomes cru-
cial. The first implies uncertain origins without connoting punish-
ment, while the second implies intent. From pestis came the French
word peste and the German Pest, as well as the English word “pesti-
lence.” Peste and Pest denote a cataclysmic outbreak of disease. But
in English the development was different: over time, the Latin word
for delivering a blow, plagare, “to strike” (from the Doric Greek plaga
[πλαγα], meaning “stroke” or “wound”), became the English word
“plague.” The same word, not accidentally, became the modern
medical name for the disease caused by the bacterium Yersinia pestis,
the organism that was responsible for the Black Death. Whereas
German, French, and other languages that use a word derived from
pestis to mean “plague” reflect the Virgilian era, the English “plague”
connects words associated with punishment (strike, blow) insepara-
bly to the idea of disastrous disease outbreaks.
k
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16 D RE A D
k
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18 DREAD
Chapter 2
PLAGUE:
BIRTH OF THE MODEL EPIDEMIC
21
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22 DREAD
today. The Black Death was the greatest disease outbreak in Western
history. Most historians agree that it killed at least a quarter, possibly
more, of the population of Europe between 1347 and 1351—perhaps
25 million people. The Black Death was the archetypal epidemic.
Aside from being an efficient killer, plague was a cataclysm on
which people piled meanings: treachery, foreignness, sanctity and
faithlessness, dying for one’s religion, obeying (or rebelling against)
authority, and, of course, the fecklessness of nature. It acquired more
layers of metaphor over time, none of which is exactly about epi-
demics, or even disease. We like to think that we see epidemic disease
objectively today—rationally, and with a science-infused awareness.
But it’s debatable whether we have significantly revised our thinking
since the first year of the Black Death.
In the 1980s AIDS seemed, literally, fabulous; it was reported as
if it were a tale from Aesop or the Brothers Grimm. Hardly anyone
questioned that the new disease was imbued with a moral. It was
called a plague. Whenever we refer to something as a “plague,” we
mean that it is subtler than we can detect, bigger than we can imag-
ine, a battle that we ought to be fighting but are not, or one that we
are fighting but do not know it. Sometimes we mean that a threat is
afoot that is capable of destroying our civilization. Or we simply sig-
nal that people ought to take things more seriously. Plague was not
only significant historically as a shaping force in European civic life.
It remains important in the lasting effects it has had on speech and
action in the public realm.
During the plague era in Europe, which lasted from that first dev-
astating outbreak in the mid-1300s until about 1700 (later in some
parts of the continent), the template by which we interpret facts
about disease outbreaks as validating our preconceived fears was
forged. At the same time, public health as we know it today became
a mainstay of the capacity of the state to guide the lives of its citizens.
k
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*The human flea, Pulex irritans, can carry plague, but it seems to do so only as
a result of the sorts of ecological disturbances that bring humans into contact
with rat fleas. In outbreaks it is Xenopsylla cheopis that spreads plague to humans.
**In general, human-to-human transmission happens only with a pulmonary
form called pneumonic plague, in which lung infection allows the bacilli to be
spread through the air to other humans via respiratory droplets.
***With the pneumonic form and another highly virulent form called sep-
ticemic (in which bacteria circulating in the bloodstream infect and grow in
internal organs), most or all human cases died of the disease; the famous
bubonic form, in which the bacteria produce swollen lymph glands, or
“buboes,” killed at least 50 percent, sometimes 80 percent, of victims.
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24 DREAD
contact with wild rodents, but they are easily treated with common
antibiotics. Continuous chains of transmission from person to person,
or rat to person to rat to person, are rare. Substantial outbreaks occur
today only in crowded conditions under unusual circumstances. For
instance, an unusually forceful earthquake in September 1993 report-
edly destroyed a million homes and led to a plague outbreak centered
in the Indian state of Sura that resulted in several hundred cases.
A plague epidemic is not simply an illness gone out of control: it
is a natural event, one that involves many changes in the environ-
ment and whose effects resonate throughout ecosystems. A sudden
outbreak of any serious disease among humans is rare. It happens
only when the circumstances are aligned just so, when an improba-
ble conjunction of climate, diet, human social arrangements, animal
and insect population dynamics, and the natural movements of
germs happens to occur. In effect, an epidemic is a kind of compli-
cated accident.
The Justinian Plague, whose first wave swept through the Mediter-
ranean trading ports in the years 541–544, struck a region that was
largely still under the sway of the Byzantine Empire (the pandemic
was named after Emperor Justinian, who reigned from 529 to 565).
The sixth-century historian Procopius reported its symptoms, fever
and buboes in the groin and armpit followed by delirium and death
within days. Plague returned beginning in the 570s and reached
Rome in 589 (it was lifted the following year, according to legend,
when Pope Gregory had a vision of the archangel Michael looming
over the tomb of Hadrian). Subsequent salients poked as far inland
as Lyon and Tours and recurred, occasionally, for two centuries. The
last outbreaks occurred in the 760s.
Thereafter, no chronicler mentioned plague in Europe for almost
six hundred years. When plague returned to Western Europe, it came
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26 DREAD
usual countryside cycle into the towns. The local rats of Asian trad-
ing centers would have carried plague-transmitting fleas to the ro-
dents that moved with the caravans. The expansion of trade after the
Crusades, linking Europe and central Asia via the Near East, created
a virtual flea bridge.
In particular, trade routes linking commercial centers provided a
network by which rats could migrate long distances and intermix
with local animal populations. By the 1300s, European ports like
Marseilles, Genoa, Naples, and Messina were well connected to
central Asia via trading centers in the Near East, such as Smyrna,
Constantinople (now Istanbul), and Kaffa (Feodosiya). The peri-
patetic rat population aboard Mediterranean and Black Sea trading
ships would have come in contact with animals on central Asian
caravans and picked up fleas from feral Asian rodents. Wild rodents
in the high country leading up to the Himalayas were especially im-
portant, because plague might have circulated at high levels among
wild mammals there.
Once in densely populated Europe, plague moved fairly quickly
from town to town. It was probably the closeness of settlements,
rather than the now-higher density of populations within Europe’s
fourteenth-century cities, that set the stage for the fast expansion of
plague after 1347. When human settlements were isolated but not
too far apart, the number of rats per human would have been high in
rural dorps or isolated households. The rat-flea-human-flea-rat cycle
would have spread the plague bacillus rapidly within such locales,
creating sudden explosions of human plague in the countryside. Fre-
quent travel between the no-longer-isolated rural settlements and
the now-larger cities in turn helped spread plague from villages
where plague was expanding rapidly but where there were few hu-
mans for it to infect to the cities, where it could spread widely
among both rats and humans.
Plague’s spread across the land in the 1340s was fast, but outbreaks
extended erratically. After appearing in Sicily in 1347, plague had af-
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fected both Barcelona and Rome by May 1348 and Paris by June of
that year—but Strasbourg, only about 250 miles from Paris, was not
stricken until eight months later, in February 1349. Plague broke out
in Mainz in August 1349 but not until 1350 in Rotterdam (only 212
miles away, and itself a seaport). In each place, the outbreak lasted for
a year or less, although in some northern climates plague vanished for
the winter but returned with warmer weather. The wave of outbreaks
moved roughly clockwise along the seacoasts, from the Mediterra-
nean northward, and from the coasts inland, then gradually eastward:
the regions that are now Italy, southern France, and Spain were af-
fected in 1348; northern France, England, southern Germany, and
Austria in 1349; northern Germany and Scotland in 1350; Poland
and the Baltic area in 1351; Moscow and environs in 1352. By the
time it was over the population was drastically reduced almost every-
where in Europe: by the mid-1400s, after a century of plague, popula-
tion had fallen by two-thirds. There were food shortages for want of
labor to bring in the harvest.
Yet in its day the question of the Black Death’s point of origin was
not urgent. On the whole, fourteenth- and fifteenth-century chroni-
clers, prelates, and officials were more concerned with how plague
spread and what could be done about it. In particular, European au-
thors writing during or shortly after the first wave of plague wondered
whether it was the work of God or Satan. “This is an example of the
wonderful deeds and power of God,” wrote ibn Khatimah in Andalu-
sia, Spain. In Ireland, John Clyn of the Friars Minor felt the world to
be “placed within the grasp of the Evil One.” The communicability
of plague was unquestioned in its own time, although the particular
mode of communication—be it contagion, intemperate air, poisoned
water, or astrological influence—was a matter of disagreement.
Pinpointing cause is a more modern concern. As plague is spread
by the bite of a flea that has been feeding on an infected rat, it is the
bacillus-transmitting flea bite that we now think of as plague’s
cause. Similarly, we say that tuberculosis is caused and spread by an
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28 D RE A D
*When the book of Leviticus was translated into Greek, lingua franca in much
of the Mediterranean basin in the third century BC, the word lepra, meaning
“scaliness,” was used to denote tzara’at. By rendering the spiritual term tzara’at
with a word that merely described the outward manifestation, the translators
lost the essential meaning of moral malaise. The translation error was perpetu-
ated about six centuries later, circa AD 400, when St. Jerome compiled the
Latin Vulgate. Although Jerome rejected the Septuagint, the Greek translation
of the Old Testament, instead translating directly from the Hebrew into Latin,
he simply accepted the Greek word lepra for tzara’at and adopted it into his
Latin translation of Leviticus. When Hansen’s disease became common in Eu-
rope, several hundred years after Jerome, it took on the name lepre in Old
French and Middle English (lèpre in modern French, leprosy in English).
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30 D RE A D
Latin version of Leviticus, thought that they were called upon to ex-
ile people with the disease “leprosy,” i.e., Hansen’s disease.
By misapplying Leviticus’s injunction about moral taint to a
physical condition, medieval Christians essentially created the leper.
Something essential was lost in translation. After the Council of
Lyon of 583, lepers were forbidden to associate with healthy people,
and laws regulating interactions with lepers were established. By the
twelfth century or so, a long list of characteristics could cause a per-
son to be labeled a leper—from various skin disorders to behavior
that signaled trouble to policy makers or the church. Unlike tzara’at,
medieval leprosy was not redressed by a period of segregation and
contemplation. Leprosy was permanent.
Lazarettos, hostels for lepers, existed in Europe from the seventh
or eighth century, but it wasn’t until the Third Lateran Council, in
1179, that all lepers were required to wear identifying insignia and
towns had to maintain lazarettos to house and feed them. Once a
specific prescription for dealing with lepers was in place, a Christian
could demonstrate his moral uprightness by giving succor to the
leper. In this way, lepers were useful to the operation of Christian so-
ciety: they were scorned but cared for, and they served as a touch-
stone by which the faithful could reassure themselves of their piety.
In medieval society, people who were disdained because they had
a disfiguring disease (or were merely imagined to represent a threat)
could exist only by living apart. In this regard, the ostracizing of the
leper foreshadowed the epidemic in the modern imagination. We no
longer banish the carriers of spiritual taint, identifying them by disfig-
urement or skin ailments. But we do identify suspicious people by skin
color, national origin, or sexual practice today as potentially infec-
tious. Certainly, that was the point of proposals early in the U.S.
AIDS outbreak to tattoo homosexual men and the reason for the drop
in patronage at Chinese restaurants in U.S. cities when the severe
adult respiratory syndrome (SARS) was spreading in Asia. We do not
refer to them as such, but lepers still exist in the modern imagination.
1586488093-text_Layout 1 1/29/10 1:24 PM Page 31
In medieval Europe, lepers and Jews were linked in the fearful minds
of many Christians. Jews, as unbelievers, were inherently “leprous.”
By 1215, Jews as well as lepers were ordered to wear clothing to indi-
cate their status, so that Christians who were pure could avoid inad-
vertent contamination.
Like lepers, Jews might be bedeviled. But Jews were not fallen
Christians, as lepers were. Nor were Jews heretics, who might seduce
believers away from the “true faith” with an alternative vision of
worship or different manner of obedience to God’s will. Jews were
suspect, but they were also valuable. Jews lent money, which made
them the object of envy, scorn, and resentment. Jews prepared food
differently—which might have contributed to accusations that they
poisoned Christian food and drink, used human blood in rituals, or
desecrated the Host. Jews were also disproportionately represented
among physicians in medieval society. It might have been easy to
imagine that physicians knew how to tinker with food and drink.
Doctors in those days, recommending powders and poultices, must
frequently have poisoned their patients inadvertently, even though
their sincere intentions were to cure. Physicians were well paid and
well dressed, too, which must have added resentment to suspicions
cast on Jewish doctors. In a society fearful of the devil’s enchant-
ments, Jews were the cause of distress.
By the fourteenth century, fear of diabolical conspiracy largely
had shifted from lepers to Jews. In 1320, the Pastoureaux, peasant
youth and children rising up against the authority of the crown in
France, targeted Jews, whom they saw as protégés of the monarchy.
The French king demanded that Jews be protected. Yet the Pas-
toureaux, along with local helpers, are said to have slaughtered
every Jew in southern France.
In the wake of the Pastoureaux rebellion, King Philip V of France
visited Poitou in the Aquitaine in 1321, where he was told that wells
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ausgedehnte Land, das hinter diesen Orten lag, wurde von den
damaligen chinesischen Geographen mit dem unbestimmten Namen
Si-yu (die Westregion) bezeichnet und soll nach ihnen in 36
verschiedene Königreiche geteilt gewesen sein. Man erzählt, daß
von China zwei Wege nach dieser Gegend führten. «Der über Lau-
lan, welcher längs des Flusses Po (des unteren Tarim?) auf der
Nordseite des südlichen Gebirges (des Altyn Ustun Tagh?) hinläuft
und westwärts nach Sa-sche (Yarkand) führt, ist der südliche Weg.
Der, welcher über den Palast des Häuptlings in Keu-tse (im
Ouigourreiche? 1890 Li von Lau-lan) führt und den Fluß Po in der
Richtung des nördlichen Gebirges (Tien Shan) bis nach Su-leh
(Kaschgar) begleitet, ist der nördliche Weg.»
188. Die Karawane auf dem Eise des Lu-tschuentsa-Baches. (S. 17.)
189. Sanddünen in der mittelsten Gobi. (S. 22.)
190. Terrasse nördlich von der Oase vom 1. Februar. (S. 22.)
191. Tränkung der Kamele am Brunnen im Lager Nr. 138. (S. 22.)
Die Steigung fährt fort, obgleich nur mit 0,644 Meter auf 11250
Meter. In dem heutigen Lager befanden wir uns also um 0,754 Meter
über dem Ausgangpunkte. Dies schien des Guten zuviel zu werden;
der Kara-koschun konnte doch nicht höher liegen als Lôu-lan! Alle
meine Gedanken und Grübeleien drehten sich um diese interessante
Nivellierungslinie. Die folgenden Tage, deren Verlauf ich mit
Spannung entgegensah, würden zeigen, ob wir nicht eine flache
Protuberanz oder Wasserscheide zwischen dem früheren und dem
jetzigen Seebecken zu passieren hatten.
15. März. Schor, den ganzen Tag Schor, tödlich einförmig! Kein
Gegenstand, auf den man das Fernrohr richten könnte, nichts, was
lockt, als die Sehnsucht, aus dieser langweiligen Wüste
herauszukommen!
Das Wetter jedoch war herrlich, und um 1 Uhr stieg die
Temperatur nur auf +11 Grad. Aber unsere Lage war insofern