No Safe Place: Disease and Panic in American History

Author(s): Margaret Humphreys

Source: American Literary History, Vol. 14, No. 4, Contagion and Culture (Winter, 2002), pp.
845-857
Published by: Oxford University Press
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Safe

No
Panic

in

Disease
and
Place:
American
History

MargaretHumphreys

The deliberatemailingof letterscontaininganthraxspores

to media and politicalpersonsin the fall of 2001 set off an epidemicpanicthroughoutthe countryfar out of proportionto the
morbidityand mortalityoccasionedby the disease.Of course,in
the beginningno one knew how many lettersthe bioterrorist(s)
had sent,or wherethe diseasemightcropup next.Newspaperstories about strangeliquidsor powdersspilledin elevatorsor post
officesthat elicitedmassivepublichealth responsebecamecommon. Patientsin my internalmedicinepracticewanted the anthraxdrugof choice,ciprofloxacin,foreverycough-just in case.
One storytold how a local doctorhad orderedhundredsof doses
of this drugfor his familymembersso theycould all takethe prophylacticregimensuggestedfor those known to be exposed in
New York,New Jersey,and Florida.
This recent experienceof 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
complacentAmericanssomeexposureto the fearthatdiseasecan
engender.Elsewherein the world ravagingepidemicsremainall
too common,butin the US we havelargelyforgottenwhatit is like
to feel that our place is contaminated,diseased,and unsafe.AffluentAmericansmaysharemanyfears-crime, travelaccidents,
cancer, or terrorists-but most of us feel that our homes and
towns are safe fromepidemicdisease.Even AIDS has becomea
preventabledisease,manageableby the conscientioususe of condoms,cleanblood products,and universalmedicalprecautions.
As a historianof epidemicdiseasein the US I havestruggled
to break throughthat sense of safety,to recreatea time when
Americangroundwas dangerousand diseaseruledboth psyche
and polity.How does one conveythe panic of 1878,whenyellow
feversweptoverthe land,forcingCongressfor the firsttimeto respond with a nationalpublichealth agency?The panic explains
this dramaticdivergencefromconstitutionand pastpractices,yet
as Lisa Lynch notes in "The FeverNext Time,"such epidemic
? 2002 OXFORD UNIVERSITY PRESS

AMERICAN LITERARY HISTORY

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846

Disease and Panic in AmericanHistory

eventscan becomean "unspeakableexperience,"one thatreveals

"the inadequacyof languagein the face of trauma."Her text is
John Edgar Wideman'sThe CattleKilling,and his protagonist
reflectson the yellowfeverepidemicof 1793:"I can say the word
plagueto you and you shudderas I shudderedhearingit beforeI
had lived througha plague. Now the word for me is merelya
word.... Attachedare memories,melancholyassociationsfrom
the time beforeI livedthroughhorrorsthe wordplagueattempts
to name.... Plagueis almosta tamewordnow... It does not, can
not, conveythe unspeakableexperiencesthat alteredmy understandingof thelife we lead on thisearth"(qtd.in Lynch).Literary
works often convey the emotion and fear that surrounddisease
betterthanmanyhistorianscan, andit is appropriatethatthisvolume combinesthe perspectivesof studentsof literatureand history. Having been asked to compose a piece for this issue that
commentson the rest, I kept comingback to the themeof panic
and the analysisof the emotivepower of contagion,epidemics,
and the personalexperienceof enduringthem.
Diseases do not cause panic in direct proportionto their
morbidityand mortality,a fact that seemscounterintuitive.During the 1980sthe diagnosisof congestiveheartfailurecarriedthe
samelikelihoodof deathwithinfiveyearsas thediscoveryof many
cancers, yet it elicited none of the latter'ssense of impending
doom. Americanwomen remainmore afraid of breast cancer
than heartdisease,althoughthe latteris muchmorelikelyto kill
them. In Illness as Metaphor (1978) and AIDS and Its Metaphors

(1989),SusanSontaghas exploredhow the significanceof certain

diagnoses,such as cancer,tuberculosis,and AIDS, goes far beyond their mere import for mortality to encompass issues of
anddemorality,bodilyintegrity,and senseof self-contamination
struction.The diseasesthat cause panic are not usuallythe diseases thatkill the most peopleon a dailybasis.
Diseasepanicand the newsmediaformtheirowngenerative
circle.Themorepanic,the morerumors,the moredemandforinformation to be supplied by the newspapers (and, later, CNN).
The last decade has seen an escalation in disease panic, with Ebola
and other hemorrhagic viruses capturing the public's attention
in fiction and the press. In fact, as Susan Moeller has argued in
Compassion Fatigue. How the Media Sell Disease, Famine, War,
and Death (1999), it is getting harder and harder to "sell"the horror of epidemics, at least those that occur outside of the developed
world. The scenarios in Outbreak(1988) and TheHot Zone (1995)
have not come to pass; the threat of Third World diseases spreading catastrophically to the First is fading. In their place the media

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AmericanLiterary History

has latchedonto the new fearsof bioterrorism.Onlytimewill tell

if thesetoo will fade or blossominto reality.
Whiletherearemanyfactorsin creatingpanic,I believethe
most essentialis the relationshipof each diseaseto its place.Yellow feverandcholeraconvertthe safelocaleto dangerousground.
Malarialiveswithinthe place,and its inhabitantsbecomeinured
to its presence.The crossingof boundariesis essentialto the creationof panic.Whenthe edge of safetycannotbe defined,people
react in ways that are not necessarilyrational-cordoning off
suspectpopulations;creatingartificialboundariesthatcreatethe
illusion of safety;fleeingsomewhere,anywhere.This sort of behaviorhappenedfrequentlywithyellowfeverandits fellowpanicengines: cholera, plague, and smallpox. Malaria never crossed
thatedge of safety,sinceit wasembeddedin the swampyenvironment and alreadythere,everysummer.Travelerscreatedpanics;
local residents,howeverunpleasant,wereacceptedas inevitable.
For the readerunfamiliarwith the historyof epidemicdisease in the US, a briefsynopsismay be useful.Cholera,a waterbornebacterialdiseasethatkillsby dehydration,visitedthe country in threeepidemicwaves:in 1832,1848,and 1866.Yellowfever
is a viral illness spreadby mosquitoesthat breed in freshwater
containerssuchas puddles,flowerpots,waterbarrels,andcisterns.
It is an urbandisease,spreadby sailingvesselsfromtropicalports
to temperatezones.Northeasterncitiessuchas Philadelphia,Boston, andNew Yorkwereafflictedin the eighteenthandearlynineteenthcenturies.For reasonsnot clear,the diseaselaterretreated
to the South, becomingan almostyearlyvisitor to New Orleans
in the two decades beforethe Civil War.In the latterhalf of the
nineteenthcenturyyellowfeverstruckaboutevery10 years,until
its finalvisitto Americain 1905.Malaria,as willbe describedlater,
wasendemicto theAmericasfromat least1680.GonefromtheUS
afterthe 1940s,it remainsentrenchedin LatinAmerica.The role
of mosquitoesin spreadingmalariawas provenin 1897.
Use of the wordpanic to describethe responseto diseases
like cholera and yellow fever has overtones of inappropriateness or excessiveness.Scholars describingthe concept "moral
panic"-which includessocialanxietiesoversubstanceabuse,sexual predatorsof children, or witchcraft-have highlightedthe
termin the past decadeand tendedto assumethat suchanxieties
are overdone.ErichGoode and NachmanBen-Yehudahave artheconcept[ofmoralpanic]dovegued,forexample,that"[c]learly
tails neatlywith the view thatthe government,the media,and the
publicareexcessivelyconcernedwith trivialor nonexistentproblems"whereasmajorissuesareignored(50). In regardto disease,

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Disease and Panic in AmericanHistory

this is a complexquestionto sort out. Perhapswe shouldbe concernedabout diseasesin just the rankorderin whichthey cause
disabilityand death. But that leaves aside aspects such as disand so
figurement,age, suddenness,unfamiliarity,preventability,
on. Certainlythe deathsof those afflictedby bioterroristanthrax
in the fall of 2001 weretragicand grievous,especiallyto theirimmediatefamilies.But did thatjustifythe terrorthatthisbioterrorist act generated?Canwe createa diseasepanic-o-meterthatcorrelatesdegreeof emotionwith some objectivescale of awfulness?
Avoidingsucha task,my goal insteadis to explorewhataspectsof
diseaseseem most proneto generateterror,without designating
the panicsthatresultas eitherlegitimateor illegitimate.
A furtherpoint aboutthe realityof theseepidemicsneedsto
be made.Yellowfever,anthrax,smallpox,leprosy,or malariaare
not bogeymenusefulforscaringthenaivebutin realitynot all that
bad. Fearof acquiringsuchafflictionsis rational,for the painand
sufferingthey engenderis all too real. The diseasesmay take on
meaningsfor individuals(such as GregoryTomsofinds for leprosyandhomosexuality)orcultures(i.e.,yellowfeverandmalaria
as a punishmentfor the evil of slavery),buttheirunderlyingphysicalitywill evokesomewhatsimilarresponsesacrosscultureand
time. Consider,for example,the followingaccount of tendinga
yellowfevervictim:"Thepoor girl'sscreamsmight be heardfor
half a squareand at times I had to exertmy utmost strengthto
hold herin bed. Jaundicewas marked,the skinbeinga brightyellow hue:tongueandlipsdark,crackedandblood oozingfromthe
mouthandnose."Thesesymptomswereuglyenough,butthenthe
terrible"blackvomit"followed:"By Tuesdayeveningit was as
blackas ink andwouldbe ejectedwithterrificforce.I hadmy face
andhandsspatteredwithit buthad to standby andhold her.Well
it is too terribleto writeanymoreaboutit."'Suchsymptomswere
specificto the particularorganismthat causedyellow fever and
createdan unavoidableset of responses--disgust,fear, horror,
and perhapscompassion.Therewas a time when one had to defend talking about malaria as a specific entity to an audience so
imbued with the social construction of disease that specific syndromes caused by specific pathogens had lost meaning as real entities. The pendulum has swung back, however, if I read the field
correctly.We have come to agree that the basic biology of specific
diseases offers an underlying reality to the historical experience of
them, while at the same time understanding that differentcultures
attach differentmeanings to epidemic outbreaks. Bubonic plague
can cause the same pus-filled buboes in 1348 and 1900, while
associated with nefarious Jews poisoning wells in the Middle

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American Literary History

Ages and disreputableChineseevadingauthoritiesin twentiethcenturySan Francisco.2

Therefore,it makessenseto discussthe role of symptomsin
creatingdiseasepanic.Putridsymptomsthatconvertthe beloved
into a nasty emitterof pus, vomit, and stool rupturethe social
bondsin familiesand createscenariosof rejectionandflight.The
blackvomitof yellowfever,consistingof partiallydigestedblood,
not onlyeruptedfromthe deliriouspatientbut gaggedattendants
with its smell.Smallpoxmade the skin slimywith pus that caked
on the sheetsand repelledtouch. Choleradischargessoakedthe
sheets,the mattress,and the floorwith fetid liquid.Evenwithout
fearof contagionthesediseasescreatedscenesof horrornot soon
to be forgotten. Comparethe quiet wasting of tuberculosis,or
the pitifulrespiratorydistressof Spanishinfluenzaor diphtheria.
Malarialikewisedoes littleto driveawaythecaregiver.Thepatient
is oftenin severedistress,withpiercingpainsin theheadandspine
anda shakingchillthatliterallyrocksthebed.At its worstmalaria
can causecoma and death,but againnothingall thatnoisomefor
attendants,howevergrievedtheymaybe by the patient'sillness.
Speed of mortalityis an importantfactorin causingpanic.
An 1832 New Yorknewspaperdescribedthe stunningspeed of
cholera in carryingaway its victims. "A prostituteat 62 Mott
Street,who was deckingherselfbeforethe glass at 1 o'clockyesterday,wascarriedawayin a hearseat halfpastthreeo'clock.The
brokendownconstitutionsof thesemiserablecreatures,perishalmost instantlyon the attack"(qtd. in Rosenberg,CholeraYears
42). Whilethe rhetoricin this articlesoughtto reassureaffluent,
prudentNew Yorkersthat they werenot at risk,it was writtenin
the climateof risingpanicthat accompaniedthe firstcholeraepidemicin the US. Yellowfeverlikewisedramaticallystruckdown
its victims;deathwithina weekof the firstsymptomswas not uncommon. Malaria and tuberculosistended to be slower,more
malariacouldbringcoma and death
chronicdiseases.Falciparum
rapidly,especially in the very young, but more often in the US
malaria resulted in a condition of chronic malaise, sometimes
slowlyevolvingtowarddeath.Yellowfevercould have an apparent mortalityas high as 50%.Cholerasimilarlycould kill thousandswithin a short span of weeks.Even though other illnesses
mightaccountfor moreof the year'smortality,the concentration
of unusualdiseaseanddeathwithina fewmonthssetsthe stagefor
panic.Theveryconceptof epidemic,a suddenrapidrisein disease
incidencethat createsa waveof morbidityand mortality,creates
a crisissituationthatthe fluctuatinglevelsof endemicdiseasesdo
not provoke.

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849

850 DiseaseandPanicin AmericanHistory

Still, the scariest diseases are travelingdiseases. Strange

plaguesthatthreatenthe placeof sanctuaryarousethe most fear.
This is particularlytruewhenthe diseasecan be tracked.In 1832
Americandoctors followedcholera'scourse across Europe,eagerlyreadingdispatchesaboutits symptoms,treatment,andpath.
Then it jumpedthe Atlanticto Montreal,breachedthe national
boundaryby mid-June,and arrivedin New York City by the
fourthof July(Rosenberg,CholeraYears23-24). In 1878a physician in ruralMississippiplottedthe courseof yellowfeverout of
New Orleanslike a weatherbuffchartinga hurricane.He saw it
reachsuccessivetownson the railroadline thatled to his own village, until at last his diaryentriescease, theirauthorsilencedby
the invader(see Wingfield).
Rumoris keyto the panic.Incompleteinformationescalates
the fear.Throughoutthenineteenthcenturythepublicfearedthat
governmentofficialswerecoveringup casesof yellowfeverto prevent panic,whichhad the oppositeeffect.Since a case of yellow
feverdid stirpanic,flight,and total disruptionof socialandcommerciallife, publichealthofficialswereverycautiousin diagnosing the first case of an epidemicseason. And since yellow fever
mimickedhepatitis B and alcoholic liver disease, two diseases
commonamongthe sailorsand otherinhabitantswho frequented
the docklandswhereyellowfeverwas often firstfound,the physician'staskwasgenuinelycomplex.Givenhow quickly"urbanlegend"storiescan travelarounda community,state,and region,it
is no surprisethatthe merestwhisperof a yellowfevercasewould
quicklyraisepanicin a population.
Giventhatthe panicdiseaseswereforeignersthreateningthe
safety of the home place, attemptsat quarantinewerenear universalin response.Until 1900,whenWalterReed and colleagues
provedthatyellowfeverwasspreadby theaedesaegyptimosquito,
debatesragedoverits contagiousnessand the need for isolation.
Similarcontroversiescharacterizethe choleradiscourse,whichis
not surprisinggivenits roleas the othermajorpanicdiseaseof the
US. But quarantineand isolationismfeatured
nineteenth-century
in thepopularresponseto eachappearanceof thesediseases,even
when doctors were disputingtheir usefulness.Tryingto erect a
barrierto keepthe homeplacesafewhilekeepingdiseaseout is an
inevitableresponseto a traveling,panicdisease.
Yellowfeveradaptedto modernmodes of transportationto
movewithinthenineteenth-century
countryside,andSoutherners
modifiedtheirquarantineideas accordingly.Shipswerestill suspect, includingsteamboatsmovingfromyellowfeverportsup the
Mississippi,Ohio, and MissouriRivers,whichmight be refused
the rightto dock by suspicioustownspeople.Trainslikewisewere

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American Literary History

deathcarriers,andmorethanone set of traintrackswasdestroyed

to preventtheirpassage.Bothtrainsandsteamboatsmightbe met
by citizens who enforced their cordonsanitairewith shotguns,
leadingto congressionaldiscussionsof shotgunquarantinesand
theirsubsequentsuppressionof trade.Peopletravelingthe roads
by foot or wagonmightlikewisebe turnedback,forcedto sleepin
the fieldswhenno one wouldtakethemin. In spiteof medicalreassuranceto the contrary,most of the populationbelievedyellow
feverwascontagious,andtheycreatedbarriersto ensurethattheir
borderof safetywas not breached.
Onealternateresponseto thepanicof yellowfeveror cholera
wasto claimthatthe diseasesdid not travelat all, butwerecreated
de novoin the locality.This was alwaysa hardsell to the general
public,but the consequenceof suchargument,the generalcleansing of a municipality,was popularanyway.Sucharguments,that
diseasearosespontaneouslyfromthe filthystreetsunderthe right
circumstances,oftenaccordedwiththebestof medicaltheory.Yet
it had to contendwith the problemof explainingwhy epidemics
appearedin someyearsandnot others.Medicalauthorstendedto
arguefor some peculiarconjunctionof weatherand filth to explain this epidemiologicalpattern-which made them quitevulnerableto ridicule.Most often, calls for urbanpurificationwere
most acceptableto the generalpopulationwhenused in addition
to protectivebarriers.The idea of makingthe home place better
ableto resistinfectionaccordedwellwitha simultaneouscreation
of a strongerborder.
Drivenby panic,the urgeto containthe infectedcould lead
to bizarrequarantinepractices.In 1900 a Chineseman died of
bubonicplaguein SanFrancisco.Theresponsewas to quarantine
Chinatown,allowingCaucasiansto move acrossits bordersbut
prohibitingthe passageof Asians.Officialsdecreedthat Chinese
bodiesweremost susceptibleto plague,perhapsbecausetheirrice
dietswerelow in protein,and thus the wayto protectthe city was
to keep the Chinesewalledinto Chinatown.A federaljudge recognized the irrationalityof this conclusion, noting that public
health authoritieshad no evidence for their hypothesisabout
Asian susceptibilities,and orderedthe quarantinecalledoff. The
epidemicsmoldereduntil it disappearedin 1904, only to return
threeyearslaterin pocketsscatteredoverthe Bay area.In the interim scientistshad discoveredthe connection between plague
andrats,so thistimethepanicfocusedon ratcatching,andChinatown was spared.3
The purveyors of American disinfectants and pesticides
have been well aware of the public's fear of contagion and the invasion of the home place. In The Gospel of GermsNancy Tomes

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Disease and Panic in American History

has emphasizedthe processby whichAmericanhousewiveswere

taught to view their homes as "whitedsepulchers,"places that
looked safe and clean on the surfacebut which harboreddeath
dealingbacteriaheretoforeunnoticed.Likewise,Americanshad
to be taughtto fearthe insectsthatspreaddiseaseand to buy the
screensand pesticidesthatwouldprotectagainstthem.In a time
when publichealth officialsblamedflies for spreadingpolio and
typhoid,cartoonsdepictedmonsterfliesthreateninginnocentbabies (see Rogers).And a popularadvertisingseriesof mosquito
cartoonsdrawnby TedGeisel(a.k.a.Dr. Seuss)urgedAmericans
to think"QuickHenry,the Flit"whenevera mosquitoappeared.
Most Americansover 55 rememberthis insecticide,which was
sprayedvia the Flit gun, familiarfrom old animatedcartoons
(Humphreys56). The themein all thesemessageswas the sameyou think your home is safe, but these hithertounseencontaminants or unappreciated,dangerousbeasts are threateningyour
family with death and disease.Yourhome place is not safe, but
you can makeit so by applyingour purifyingproduct.
Anotherway to createa borderbetweenoneselfand the infectedspaceis to map the troubleareasand thus be ableto study
andcontrolthem.Thisis one of thecoretools of epidemiology.Its
use by JohnSnow is probablythe most famousearlyexampleof
the technique.He hypothesizedthat cholera could be spread
throughthe watersupplyand noted that in one London neighborhoodthereweretwo watercompanies,one thatdrewfroman
areaof the Thamesless contaminatedby sewagethanthe second.
He mappedthe houses that receivedwaterfrom the two companies and then mappedcholera incidencein the same neighborhood, showingthatthe dirtierwatercorrelatedwitha greaterlikelihood of infection. Maps of yellow fever epidemicshave been
employedto demonstrateproximityto the waterfrontand other
factors in an attemptto explain the disease. Mappingis about
wherethe diseaseis, and drawingthe picturebeginsto give some
idea of how to containand understandit.4
PriscillaWald discusses how this techniquewas similarly
used to understand the process and problems of urbanization in
the early twentieth century. It is probably not too extreme to say
that many Americans responded to the influx of foreign immigrants from the 1880s to the 1920s with a kind of nativist panic.
Many disease panics in this time period were tied to nativist fears,
including responses to Jewish immigrants and typhus in 1892,
plague and the Chinese in 1904, and polio and Italians in New
York City in 1916. Mapping the urban landscape was one way to
get a handle on this burgeoning population, so foreign, so strange,

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American Literary History

so threatening.The contagionof disease,the contagionof socialism, the verycontagionof foreignnesswereall mademoreassimilable and less frighteningby maps that described,limited, and
contained.
Diseasepanicsdid servea purpose,however.It is also worth
rememberingthat they wereoften quitejustified.Panicsspurred
reform,particularlyreformsthatrequiredspendingpublicmoney.
The thirdcholerapanicof the mid-1860sin the US led to the creation of the MetropolitanBoard of Health in New York City.
CharlesRosenberghas saidof this event:"[T]hereis no datemore
importantthan 1866,no eventmore significantthan the organizationof the MetropolitanBoardof Health.Forthe firsttime,an
Americancommunityhad successfullyorganizeditself to conqueran epidemic.Thetools andconceptsof an urbansocietywere
beginning to be used in solving this new society's problems"
(CholeraYears193). Rosenbergis referringto the fact that the
MetropolitanBoardmadeuse of JohnSnow'sworkon cholerato
focus on disinfectingthe stools of cholera patients, as well as
cleaningthe streetsanddisinfectingprivies.Thecholerapaniccreatedan enormousforcefor reformand change.
Yellowfeverpanicwas evenmorepowerful.The diseaseoccurredmore often than choleraand cost more money in lost interstatetrade.In 1878 a massiveepidemicragedthroughoutthe
Mississippiand Ohio Valleys.In responseto the nationalyellow
feverpanic,Congresscreatedthefirstfederalpublichealthagency,
the NationalBoardof Health,in 1879.As the panicebbedin subsequentyearsso did the fateof thisinstitution,whichlost its funding after 1883.But whenyellowfeverflaredagainin 1888and in
the 1890s,the accompanyingpanicdrovethe transitionof an obscure federalagency chargedwith caring for sick sailors of the
merchantmarineinto the US PublicHealthService.Yellowfever,
along with anxietiesabout cholera(1892) and plague(1904 and
1906),led to the congressionalconclusionthat the US neededa
permanent, national public health authority.
Oddly enough, cholera does not seem to have stirred the
panic in the Philippines that Warwick Anderson's American
physicians expected. When American public health workers were
replaced with newly trained Filipino ones, American observers
commented that they merely imitated the proper procedures,went
through the motions but failed to apply appropriate rigor. One
Rockefeller Foundation field man, Dr. William S. Carter,found it
"discouraging to try to do something for people who will not do
anything for themselves . .. the inertia of these people passeth all
understanding." One essential component for panic, as opposed

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Disease and Panic in AmericanHistory

to resignation,is the assumptionthatsomethingcan be done,that

somethingshould be done. Commonthemesin the medicalhistory of colonialismincludethe clash of Westernand indigenous
diseaseconceptsand the sometimes-baffling
(to Westerners)apaof
colonial
in
the
face
of
thy
peoples
epidemics.Questionsabout
and
disease
have
occurredin thecolonial
when,where, why
panics
settingmightwell rewardhistorianswith insightsinto this interactionbetweenWesternand indigenousdiseasemodels.
Malariausuallydid not cause panics,even though it could
cause very high mortalityin virginpopulations.In the 1830san
epidemic raged among west-coast Indian populations, killing
largenumbersof them.We haveno recordof theiremotionalresponse,but one wouldexpectpanicwhen therewerenot enough
living left to bury the dead, as Euro-Americancommentators
noted. Britishsoldiersstationedin west Africain the earlynineteenth centurydied at a fierceratefromfalciparummalariaand
yellow fever,promptingBritishauthoritiesto replacewhite soldierswith black ones. Falciparummalarialed to a chronicstate
of sicknessin the tropicaland subtropicalplantationsof the New
World,generatingconditions that favoredAfrican slaveryover
other possiblelaborchoices for the AmericanSouth, the Caribbean, and Latin America. Malariacould, in other words, be a
powerfulpresence.But once settledinto the landscape,it usually
did not inducediseasepanics.
From the days of Hippocratesphysiciansand laypersons
alikeknewwhatcausedmalaria.Thefoulairarisingfromswamps,
the product of rotting plants in stagnantwater,generatedthe
achesandfeversof malaria.Thediseasewasconfinedto place;the
place itselfwas unhealthy.The people who livedin thatplace becameunhealthy,butif theymovedawayfromit, to higherground,
theyleft the diseasebehindthem.Therewas no reasonto fearthe
patientwith malaria.Rather,the thingto fearwas the placeitself.
One might have thought that this would change after the discoveriesof the late nineteenthcenturydemonstratedthat an organism transmitted by a mosquito caused malaria. Presumably,
people with malaria should now be seen as dangerous, since they
served as disease carriers. But so much of the literature about
malaria focused on the mosquito and its breeding place that the
attention remained on the swamp, on the land. The infected person was still, oddly, almost incidental to the chain of infection. Exceptions to this rule can be found, but by and large, dangerous
mosquitoes merely replaced poisonous swamp gases as the dangerous feature of the swampy environment.
People who lived in such environments tended to adopt a

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American Literary History

resigned attitude toward the inevitabilityof malaria. Charles

Dickens discovered this mentality in people living along the
MississippiRiverin his trip to Americaduringthe 1840s.In his
nonfiction work American Notes and later in Martin Chuzzlewit,

Dickenssketcheda populationsoakedin malaria,having"anair

of great despondency and little hope on everything"(qtd. in
Humphreys32). His eternallycheerfulcharacterMark Tapley
makeslightof the situation,buthe is also realisticin his claimthat
"wemust all be seasoned,one way or the other.That'sreligion,
that is, you know"(32). A Southernphysicianlaterlamentedthis
apatheticdefeatism:"Malariais such an insidiousdiseasethat it
is generallyconsideredlightly,as a necessaryevil of little importance,by thosewho livein localitieswhereit prevails"(Bass339).
A PublicHealth Serviceeducatorwas similarlyfrustratedin his
attemptsto convincean audiencethatmalariawas preventableif
certainstepsweretaken."TheNegroesaccept'chills'as a necessaryevil and pay it scant attention,"he despaired(Maxcy 1119).
Malariawas not seenas travelingand invading;rather,it lounged
and lurked,permeatinga placewith chronicdisease.
Malariacontrolrarelyarousedlegislativeintereston the orderof yellowfeverandcholera.Althoughtherewerefederal,state,
andlocal publichealthofficials,aidedby the RockefellerFoundation, who took on the diseasein the firstdecadesof the twentieth
century,they did so using argumentsabout malaria'simpacton
the economy.It was saidthatmalariamadefor sickly,tiredworkers and draggeddown the developmentof a region.Malariasucceeded in attractingsome attentionand money,but did not become a major playeron the national stage until WorldWar II.
Malariasuddenlybecame of nationalimportin the early 1940s
becausenon-Southernsoldierswereheadingsouthin greatnumbers.Majormilitarybases werelocatedin the South, and as the
countryrampedup for entry into WorldWarII, a greatflux of
menmovedthroughthem.The placehad not changed,but now it
was the valuedpersontravelingfromthe safe place into the dangerousthatcreateda nationalurgencyto controlmalaria.Within
the US Public Health Service a new office appeared, assigned to
maintain Malaria Control in War Areas (MCWA). After the war
MCWA expanded its duties to a full-scale eradication of malaria
from the South using DDT; in 1947 the name was changed to the
Communicable Disease Center (CDC, later renamed the Centers
for Disease Control). Once malaria faded from the US by the end
of the 1940s, the CDC became a surveillance agency, watching for
the invasion of the home turf by threatening diseases. Malaria
briefly aroused something like panic in World War II, but only

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855

856

Disease and Panic in American History

becauseof the unusualproximityof the valuedbodies of American soldiersand the malariousenvironment.

The aftermathof disease panics is grief. People mourned
deaths from malariajust as they mourneddeaths from yellow
fever,but the latter had experiencedsomethingmore than the
single loss. The communalfear,the communalsense of invasion
and loss of safety,deepenedthe scarsbroughtby deadlydisease.
Suchexperiencesmayperhapscallforcommemoration,to be preservedin memory.Or to be burieddeeply,forgottenas the 1918
influenzaepidemicseems to have been. Warscreateheroessuitable for statues,wreaths,and other sentimentalmarkers,while
epidemicsaremoreproblematic.True,thereare occasionallyheroes,suchas WalterReedand ClaraMaass,rememberedfortheir
dangerousworkon yellowfeverand each with a hospitalnamed
for them. But these are scienceheroes,not the heroesof disease
panics.The epidemicsthemselvesare rememberedin a few museum exhibits,most notablyin Memphisand New Orleans.But
mostlythe occurrenceof these epidemicsis forgottenamongthe
generalpublic.
Historians struggle to convey the emotions of epidemic
eventswhilemovies,poetry,and literatureoften conveythemfar
more profoundly.The horror genres, whether books or films,
knowjust how to tap into our fears of overwhelmingdisease,as
Schell'sessay on the virus that is conqueringthe world shows.
Evenin the US our senseof complacentsafetyhas anedge of anxiety that loves to be titillated.But the anthraxscare and subsequent discussionsof other bioterroristagents such as smallpox
havesuddenlybroughtthepossibilityof diseasepanicmuchcloser
to the surface.Malaria,yellow fever,cholera,and polio may be
snuffedbogeymenon Americansoil, but we need to give much
thoughtto "thepanicnexttime"(to borrowfromLynch'stitle).
Notes
1. W E. George to My dear friend, 4 Nov. 1897, Van Dyke Collection, Mississippi Valley Collection, The University of Memphis, Memphis, TN.
2. On the mixture of biological and culture parameters in the understanding of
disease see Rosenberg, "Framing Disease."
3. See Kraut, 78-98; and Risse.
4. See Jarcho;and Rosenberg, Cholera Years,193-94.

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American Literary History

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857