Plagues:Perceptions of Risk and Social Responses William H. Foege (bio) polybius taught us, over 2000 years ago, that the world is an organic whole,1 where everything affects everything. Plagues demonstrate that truth—crossing cultures, crossing time, but also joining cultures and time inextricably, influencing the births and deaths of people, careers, and nations. Indeed, in a recently overworked phrase, "plagues bend history." Perhaps rivaling the Black Death, which has received so much attention, was the pandemic of cholera which broke the boundaries of India in the early nineteenth century, moved across Russia by 1830, caused havoc at Mecca in 1831, moved across Europe in 1831 and 1832, arrived in the United States and went by canal boat to Albany and then to the Missouri River by 1833, where it became the determining factor for many wagon trains over the next years. In 1835, Marcus Whitman, the first medical missionary to the American west, made his initial journey to Oregon and was credited with saving a wagon train by stopping a cholera outbreak.2 That epidemic allowed him to earn his reputation and start a career. Twelve years later, another epidemic, this one of measles, led to the Whitman Mission massacre, ending his career and the lives of the mission personnel.3 The Whitman Mission story becomes a paradigm for what has happened across cultures and nations. In the early eighteenth century, British troops began to receive variolation with smallpox virus, after Lady Montagu introduced the practice she had observed in Turkey, [End Page 305] where her husband was ambassador.4 Fifty years later, the battle of Quebec, where American troops outnumbered the British two to one, was lost by American troops when smallpox swept through their ranks but spared the British troops who had been variolated. (Some Canadians to this day worship smallpox as the deliverer from United States citizenship.) In 1801, Thomas Jefferson acquired smallpox vaccine and personally administered it to his family and neighbors at Monticello. In 1804, he gave vaccine to Lewis and Clark, instructing them to administer it to Indians because of their high mortality rates due to smallpox. But it was too little and smallpox opened the west, decimating tribes and breaking their spirit. DeVoto writes about the 1837 outbreak, "All summer long not a single Indian came to Fort McKenzie. … Early in the fall Culbertson set out to … find out what was wrong. … Then at the Three Forks he found a village. No sound came from it as he approached, there were no horses or dogs, no children, no uproar. Presently they smelled the stench and then 'hundreds of decaying forms of human beings … lay scattered everywhere among the lodges.'"5 On July 14 a young Mandan died of smallpox. Six months later only a hundred of the 1600 Mandans were still alive and no tribal organization could be maintained. There are no full-blooded Mandans today. What lessons have we learned from this continuous flow of plague history? Are we truly better off because of what has happened upstream, or do the problems continue to change so dramatically that the lessons are only marginally beneficial? In this first session, we can only touch on some of the lessons of plague history. My attempts will be modest—to say something about: (a). the definition of plagues (b). the perception of risk (c). responses [End Page 306] DEFINITION The definition of plague offered by the 1986 Webster Medical Desk Dictionary, describing plague as an epidemic disease causing a high rate of mortality, is inadequate for several reasons. Epidemiologists now commonly use the term epidemic to describe an unusual occurrence of a disease or condition. Thus, while a single case of smallpox would constitute an epidemic, the million cases of gonorrhea each year in the United States would be considered an endemic disease but not necessarily an epidemic. Therefore, two problems with Webster's definition of the term are particularly significant. First, plagues do not have to be epidemic: a plague can be endemic, a constant presence. Second, mortality rates should not be the criterion for measurement. In describing one plague, the Old Testament notes the presence of fiery serpents, now known to be...
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Jul 15, 2023
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