What Is an Epidemic? AIDS in Historical Perspective

We use the term epidemic in a variety of ways—most of them metaphorical, moving it further and further from its emotional roots in specific past events. Even in relation to health, we employ the word in contexts decreasingly related to its historical origins. Medical historians speak of an epidemic of tuberculosis in Europe between 1700 and 1870 and of an epidemic of rheumatic fever in the century and a quarter after 1800. In the mass media every day, we hear of "epidemics" of alcoholism, drug addiction, and automobile accidents.¹ These cliched usages are disembodied yet at the same time tied to specific rhetorical and policy goals. The intent is clear enough: to clothe certain undesirable yet blandly tolerated social phenomena in the emotional urgency associated with a "real" epidemic.

Defining aspects of that millennia-old reality are, of course, fear and sudden widespread death. It is plague and cholera, yellow fever and typhus that we associate viscerally with the experience of epidemics, not alcohol and automobiles. AIDS has reminded us forcefully of that traditional understanding. But there is another defining component of epidemics that needs emphasis, and this is their episodic quality. A true epidemic is an event, not a trend. It elicits immediate and widespread response. It is highly visible and, unlike some aspects of humankind's biological history, does not proceed with imperceptible effect until retrospectively "discovered" by historians and demographers.

Thus, as a social phenomenon, an epidemic has a dramaturgic form. Epidemics start at a moment in time, proceed on a stage limited in space and duration, follow a plot line of increasing and revelatory tension, move to a crisis of individual and collective character, then drift toward closure. In another of its dramaturgic aspects, an epidemic takes on the quality of pageant-mobilizing communities to act out proprietory rituals that incorporate and reaffirm fundamental social values and modes of understanding. It is their public character and dramatic intensity—along with unity of place and time—that make epidemics as well suited to the concerns of moralists as to the research of scholars seeking an understanding of the relationship among ideology, social structure, and the construction of particular selves.

For the social scientist, epidemics constitute an extraordinarily useful sampling device—at once found objects and natural experiments capable of illuminating fundamental patterns of social value and institutional practice. Epidemics constitute a transverse section through society, reflecting in that cross-sectional perspective a particular configuration of institutional forms and cultural assumptions. Just as a playwright chooses a theme and manages plot development, so a particular society constructs its characteristic response to an epidemic.

Contemporary America's experience with AIDS has already provided materials in abundance for analysis based on such assumptions. In many ways we have reenacted traditional patterns of response to a perceived threat. But if we are to understand our contemporary reaction to a traditional stimulus, we must distinguish between the unique and the seemingly universal, between this epidemic at this time and this place and the way in which communities have responded to episodic outbreaks of fulminating infectious disease in the past. We have become accustomed in the last half century to thinking of ourselves as no longer subject to the incursions of such ills; death from acute infectious disease has seemed—like famine—limited to the developing world. Life-threatening infectious ills had become, almost by definition, amenable to therapeutic or prophylactic intervention. AIDS has reminded us that this sense of assurance might have been premature, the attitudinal product of a particular historical moment. AIDS has shown itself both a very traditional and a very modern sort of epidemic, evoking novel patterns of response and at the same time eliciting—and thus reminding us of—some very old ones.

Epidemic Incident as Dramaturgic Event

The narrative of Camus's Plague begins on a strikingly circumstantial note. "When leaving his surgery on the morning of April 16, Dr. Bernard Rieux felt something soft under his foot. It was a dead rat lying in the middle of the landing. On the spur of the moment he kicked...