The Plague: On the Evil and on the Good, on the Just and on the Unjust

THE PLAGUE: ON THE EVIL AND ON THE GOOD, ON THEJUST AND ON THE UNJUST JOHN L. DUSSEAU* When leaving his surgery on the morning of April 16, Dr. Bernard Rieuxfeltsomethingsoftunderhisfoot. Itwasadeadratlyingin themiddle of the landing. He kicked it to one side and, without giving it afurther thought, continued on hü way downstairs. Only when he was stepping out into the street did it occur to him that a dead rat had no business tobe on his landing. [Camus (1, p. 7)] Of all diseases destructive to human life none is so dramatically lethal as the plague, the great scourge of humankind. It had long been observed that outbreaks of a deadly disease of rats and mice preceded the onset of human plague. However, this knowledge was not used as an effective weapon against plague except as the obscure impulse for the first quarantine. The Republic of Ragusa in the fourteenth century adopted and extended the Venetian regulations forbidding entry into the city of persons infected with plague, which was again advancing in Europe. A landing station was established away from the city, and there any incoming persons suspected ofhaving the disease or ofcoming from places infested with rat plague had to spend 30 days—known as the Trentina—in the open air and sunlight. Later this period was found insufficient and extended to 40 days—the Quarantina—whence we have the word "quarantine" [2, p. 81]. Quarantine may now be regarded as an inhumane and ineffective preventive ofplague; but it probably served its purpose in the eighteenth century, when plague occurred in the Near East, extending to Russia, where 150,000 died of it in 1709, and to Marseilles and Toulon, where 90,000 died in 1720. But die onslaught then faded away, possibly because of isolation of persons suspected of harboring the disease. Such drastic measures seemed unnecessary after»Address: 609 Fox Fields Road, Bryn Mawr, Pennsylvania 19010.© 1982 by The University of Chicago. All rights reserved. 0031-5982/83/2601-0314$01.00 46 I John L. Dusseau · The Plague the identification of the plague bacillus by Shibasaburo Kitasato, a pupil of Koch, and by Alexandre Yersin, a pupil of Pasteur, during an epidemic at Hong Kong in 1894. These two observers separately cultivated the organism and reproduced the disease by inoculation of pure cultures in animals [2, p. 253]. Meantime a mass of evidence has been collected demonstrating that the normal carrier ofplague infection is the rat flea, and this knowledge has led to seemingly effective measures of control, although one may question whether complete extermination of the rat population or their infective fleas is a realizable aim. Various prophylactic measures for the safety ofindividuals have evolved, and it is established that Yersinia pestis is sensitive to sulfonamides and many antibiotics . But recent reports from Southeast Asia indicate emerging resistance of the bacillus to drugs, and there is evidence diat die incidence of plague in the United States and in other developed countries is increasing [3, p. 376; 4, pp. 86-88]. Although we may mistakenly assign plague to the roster ofconquered diseases, the old pictures of its ancient virulence persist in the mind: "Athens, a charnel house reeking to heaven and deserted even by the birds; Chinese towns cluttered widi victims silent in their agony; the convicts at Marseilles piling rotting corpses into pits; . . . cartloads of dead bodies rumbling through London's ghoul-haunted darkness— nights and days filled always, everywhere, with the eternal cry ofhuman pain..." [1, p. 269]. The number ofvictims ofthe Black Death is beyond computation; but in the fourteenth century it devastated the earth, killing over 60,000,000 human beings—one-fourth the population of the world. Outbreaks of plague have often been associated with other disasters. Earthquakes, great conflagrations, and violent floods preceded the outbreak of plague in Constantinople in 540. Impoverishment and displacement ofthe population, breakdown of agriculture, and widespread famine played their role in spread of the pestilence. The visitation in Byzantium itselfwas relatively brief; but in its total course over the earth, the epidemic had an influence on the history of man whose importance cannot be overstated. The great plague ofJustinian began in Egypt, and Procopius...