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IN
TIME OF PLAGUE
THE HISTORY AND SOCIAL CONSEQUENCES OF LETHAL EPIDEMIC DISEASE Volume 55 No. 3 (Autumn 1988) Arien Mack, Editor |
Table of Contents Notes on Contributors Ordering information
The papers in this issue were presented at a public conference entitled "In Time of Plague: The History and Social Consequences of Lethal Epidemic Disease," sponsored by Social Research. It was held in January at the New School for Social Research and was the first in what we hope will be a series of such conferences. The conference was made possible by the generous support of the Rockefeller Foundation and the Edna McConnell Clark Foundation. The initial plans for this conference emerged at a planning meeting in the fall of 1986 attended by Gert H. Brieger, William H. Welch Professor of the History of Medicine, Johns Hopkins; John Hollander, poet and professor of English at Yale University; Shirley Lindenbaum, anthropologist and colleague at the Graduate Faculty of the New School; Dorothy Nelkin, professor, Program of Science, Technology and Society, Cornell University, currently Clare Boothe Luce Visiting Professor, Department of Sociology, New York University; Kenneth Prewitt, political scientist and vice president of the Rockefeller Foundation; Susan Sontag, novelist and critic; Paul Starr, sociologist and professor at Princeton University; Jamie Walkup, editorial associate and co-organizer of the conference, and myself.
An exhibit, "In Time of Plague: Five Centuries of Infectious Disease in the Visual Arts," was held at the American Museum of Natural History in conjunction with the conference. It was made possible by a grant from the Rockefeller Foundation. Its curators were Daniel Fox, professor of humanities in medicine, State University of New York, Stonybrook, and Diane R. Karp, art historian and freelance curator. The exhibit was jointly sponsored by the American Museum of Natural History and the New School for Social Research. The medal pictured on the cover is one of the artifacts from that exhibit.
The conference was organized with the expectation that an open discussion among scientists and scholars might help to place the current alarming outbreak of AIDS in perspective by considering it in the context of the social history of past lethal epidemics. We thought that focusing attention on the many ways in which diseases, particularly catastrophic infectious and contagious diseases, are and have been both biologically and socially defined might help lead the way to a calmer and more effective public response to the problem.
Why, you might well ask, if we hoped the conference and this subsequent issue of Social Research might help create the possibility of a calmer and more reasoned response to AIDS, did we give it so ominous and threatening a title as "In Time of Plague"? There are at least two reasons. First, for good or ill the word "plague" effectively captures the emotional associations frequently engendered by reports about AIDS. The word acknowledged the unfamiliar fears it has awakened. After decades of dividing our time between apocalyptic fears of nuclear holocaust and private fears of personal ruin, we now face a threat that is profoundly social, requiring a public, community response. Most of us until recently have assumed, perhaps without thinking, that the number of life-threatening infectious diseases was finite, soon to be cured and prevented by medical science. So the study of plagues was delegated exclusively to medical and social historians. Now it appears that this idea that we stand outside our own history, that we, unlike our forebears, are immune to widespread medical disasters, is very doubtful.
The word "plague" appears in the title for a more specific reason as well. Its presence points the way to the problem that must be addressed. In fact, the problem we face can be seen in the very considerations that made the word seem appropriate, for the exotic connotations of the term exercise their influence over our emotions, even when the word itself is not spoken. The fact is that the past is both too much and too little with us in our public deliberation about AIDS; its images of disease affect us precisely because we so rarely take them into account. The hope is that these scholarly discussions will allow our present and our past to speak with each other. With luck they may permit us to discern the similarities between our past and our present, untangle overlooked differences, and reflect on how we should now act.
The issue is divided into sections which parallel the conference sessions, and each section is introduced by the moderator of the session in which the papers were presented. The first section, "The Definition and Control of Disease," is concerned with a group of related questions:
(a) How has the definition of disease differed in different historical moments? Are there cultural invariants that determine how diseases are perceived or defined? How does the definition of disease as a consequence of behavior, the presence of some biological process, or as the manifestation of a particular set of symptoms affect the social response?
(b) How have the new technologies, advances in the science of epidemiology and mass information gathering changed our perception and response to disease? Under what circumstances has it been deemed appropriate, or is it appropriate to control information or behavior? For example, when has quarantine been appropriate or effective?
(c) What problems follow from reporting the results of medical research to the public?
The second section contains only one paper, the address given on the evening of the opening of the conference. This paper by Lewis Thomas, "Science and Health: Possibilities, Probabilities and Limitations," presents an optimistic view of what the future of medical science promises us.
The third section, "Case Histories," contains three papers, two of which recount the social histories of earlier plagues, the Black Death and syphilis, while the remaining paper, by Baruch Blumberg, tells the story of hepatitis B and the search for a preventative vaccine.
The three papers in the last section, "Moral Dilemmas," concern the thicket of moral problems raised by the presence of lethal, contagious diseases. What norms should govern our thinking about responsibility, culpability, legality, and confidentiality? What does society owe the victims? What are the responsibilities of the carrier population? How do we deal with the patient's right to privacy in the face of the physician's duty to warn the public's right to know?
Both the conference and these collected papers at their best illustrate how much there is to be learned from a colloquy among scientists, social scientists, and philosophers, all of whom are concerned with common problems.
Arien Mack
Editor
Table of Contents
Notes on Contributors
(at time of publication)
Baruch S. Blumberg a 1976 Nobel laureate, is vice president of the Fox Chase Cancer Center in Philadelphia and university professor of medicine and anthropology at the University of Pennsylvania.
Allan M. Brandt associate professor of the history of medicine and science at Harvard University, is the author of No Magic Bullet: A Social History of Venereal Disease in the United States since 1880 (1985).
Willian H. Foege is executive director of the Carter Center in Atlanta.
Sander L. Gilman is Goldwin Smith Professor of Humane Studies at Cornell University and author of Disease and Representation: Images of Illness from Madness to AIDS (1988).
George Kateb is professor of politics at Princeton University. His most recent book is Hannah Arendt: Politics, Conscience, Evil (1984).
Joshua Lederberg a 1958 Nobel laureate, is president of Rockefeller University.
Dorothy Nelkin Professor of sociology at Cornell University, is currently Clare Boothe Luce Visiting Professor at New York University. She is the author of Selling Science: How the Press Covers Science and Technology (1987).
Richard Poirier is Marius Bewley Professor of English at Rutgers University, editor of Raritan Quarterly, and author, most recently, of The Renewal of Literature (1987).
Anthony Quinton formerly president of Trinity College, Oxford, is now chairman of the British Library. His most recent book is Thought and Thinkers (1982).
David A. J. Richards is professor of law at New York University. His most recent book is Toleration and the Constitution (1986).
Charles E. Rosenberg is Janice and Julian Bers Professor of the History and Sociology of Science at the University of Pennsylvania. His most recent book is The Care of Strangers: The Rise of America's Hospital System (1987).
Barbara Guttmann Rosenkrantz is professor of the history of science at Harvard University. She is the author of Public Health and the State (1972).
Paul Slack is a fellow and tutor in modern history at Exeter College, Oxford. His most recent book is Poverty and Policy in Tudor and Stuart England (1988).
Lewis Thomas president emeritus of the Memorial Sloan-Kettering Cancer Center in New York City, is currently scholar in residence at Cornell University Medical College.
