Contagious: Cultures, Carriers, and the Outbreak Narrative (review)

As culture critic Roger Rosenblatt reminds us, "story-telling is what the human animal does, to progress, to learn to live with one another." English professor Priscilla Wald analyzes a particular genre of recurring story, the account of the communicable disease outbreak, the history of which is especially compelling in light of contemporary concerns about HIV/AIDS, SARS, Avian Flu, and drug-resistant strains of tuberculosis. She intends her interdisciplinary analysis of outbreak narratives to aid scholars in their understanding of disease's impact upon society. Such understanding might then lead to "more effective, just, and compassionate responses both to a changing world and to the problems of global health and human welfare." (3)

Outbreak narratives share a "formulaic plot," according to Wald. Each narrative, whether in fact or fiction, begins with "the identification of an emerging infection, includes discussion of the global networks throughout which it travels, and chronicles the epidemiological work that ends with its containment." (2) Wald begins in the midst of the bacteriological revolution which began in the late nineteenth century. In the treatment of Mary Mallon (a.k.a. Typhoid Mary) in the early twentieth century, Wald locates an early and culturally powerful factual outbreak narrative. George Soper, a clever epidemiologist traced typhoid deaths at a summer house to a female Irish immigrant cook, a healthy carrier, who is unwittingly spreading infection to those who ate food she prepared. It was an era before such phenomena were widely understood, and Mary's insistence of innocence, her pursuit, and her detention in isolation arouses sympathy for both the dead and for Mary, who emerges as a victim of her own body and a fearful society.

Wald looks to similar historical narratives in the Cold War era and, more recently, in exchanges about the HIV/AIDS pandemic. In literature, Wald locates the outbreak theme in Michael Crichton's Andromeda Strain (1969) and Richard Preston's Hot Zone (1994). On the screen, there is Invasion of the Body-Snatchers (1956 and 1978 versions). These stories include a patient zero (the first to contract the disease), superspreaders, hot zones, and persistent pathogens, or invaders. Wald prods readers to consider how humans respond to the biological invasions of their bodies, especially by microorganisms. Her examples remind us that increasing human connectedness with its gift of shared information, also imperils us by the speed with which disease is spread.

Citing journalist Laurie Garrett's The Coming Plague (1994), Wald suggest the possibility of a counter-narrative in which the world, with some humility, reconceptualizes humanity's place in the Earth's ecology and acts locally and globally to ensure every person's right to the highest possible level of health through reform in the distribution of medical care and banishing the extreme poverty that triggers outbreaks of disease. Wald also sensitizes readers to how contagion spreads and whom it affects. She cautions against confusing disease and victim, hoping to diminish medicalized prejudice and stigma often assigned to sufferers.

Contagious is too rich in detail and cultural reference for most undergraduates, but scholars of American culture will applaud it. It is unlikely that Wald's cultural critique with its plethora of examples from novels and films offers the kind of data that can alter America's medical landscape, but thoughtful physicians, nurses, and public health workers who do encounter her book will never battle an "outbreak" without pondering how it might give rise to yet new cultural expressions, symbols, and social relationships.