No Safe Place: Disease and Panic in American History

The deliberate mailing of letters containing anthrax spores to media and political persons in the fall of 2001 set off an epidemic panic throughout the country far out of proportion to the morbidity and mortality occasioned by the disease. Of course, in the beginning no one knew how many letters the bioterrorist(s) had sent, or where the disease might crop up next. Newspaper stories about strange liquids or powders spilled in elevators or post offices that elicited massive public health response became common. Patients in my internal medicine practice wanted the anthrax drug of choice, ciprofloxacin, for every cough—just in case. One story told how a local doctor had ordered hundreds of doses of this drug for his family members so they could all take the prophylactic regimen suggested for those known to be exposed in New York, New Jersey, and Florida.

This recent experience of disease panic in the US pales in comparison to the historical responses to epidemics such as yellow fever, polio, cholera, and smallpox. But it gives otherwise complacent Americans some exposure to the fear that disease can engender. Elsewhere in the world ravaging epidemics remain all too common, but in the US we have largely forgotten what it is like to feel that our place is contaminated, diseased, and unsafe. Affluent Americans may share many fears—crime, travel accidents, cancer, or terrorists—but most of us feel that our homes and towns are safe from epidemic disease. Even AIDS has become a preventable disease, manageable by the conscientious use of condoms, clean blood products, and universal medical precautions.

As a historian of epidemic disease in the US I have struggled to break through that sense of safety, to recreate a time when American ground was dangerous and disease ruled both psyche and polity. How does one convey the panic of 1878, when yellow fever swept over the land, forcing Congress for the first time to respond with a national public health agency? The panic explains this dramatic divergence from constitution and past practices, yet as Lisa Lynch notes in "The Fever Next Time," such epidemic events can become an "unspeakable experience," one that reveals "the inadequacy of language in the face of trauma." Her text is John Edgar Wideman's The Cattle Killing, and his protagonist reflects on the yellow fever epidemic of 1793: "I can say the word plague to you and you shudder as I shuddered hearing it before I had lived through a plague. Now the word for me is merely a word. . . . Attached are memories, melancholy associations from the time before I lived through horrors the word plague attempts to name. . . . Plague is almost a tame word now. . . . It does not, can not, convey the unspeakable experiences that altered my understanding of the life we lead on this earth" (qtd. in Lynch). Literary works often convey the emotion and fear that surround disease better than many historians can, and it is appropriate that this volume combines the perspectives of students of literature and history. Having been asked to compose a piece for this issue that comments on the rest, I kept coming back to the theme of panic and the analysis of the emotive power of contagion, epidemics, and the personal experience of enduring them.

Diseases do not cause panic in direct proportion to their morbidity and mortality, a fact that seems counterintuitive. During the 1980s the diagnosis of congestive heart failure carried the same likelihood of death within five years as the discovery of many cancers, yet it elicited none of the latter's sense of impending doom. American women remain more afraid of breast cancer than heart disease, although the latter is much more likely to kill them. In Illness as Metaphor (1978) and AIDS and Its Metaphors (1989), Susan Sontag has explored how the significance of certain diagnoses, such as cancer, tuberculosis, and AIDS, goes far beyond their mere import for mortality to encompass...