AIDS, Fear and Society

Challenging the Dreaded Disease

Kenneth J. Doka

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781135913571
• Edition: 1
• Topic: Medicina
• Subtopic: Salud general

Historically, AIDS is just one of a series of dreaded diseases that have aroused both great fear and irrational actions. The previous diseases, including bubonic plague, syphilis, tuberculosis, leprosy and cancer, have evoked such a sense of dread that rational moves to halt the disease have become compromised.; This text examines the deep sense of fear that AIDS evokes, stigmatizing those who suffer from the disease, as well as their families and caregivers. Until AIDS can be seen for what it actually is - a life-threatening disease - policies providing for humane treatment will not evolve. The book also emphasizes that diseases are more than biological phenomena or individual catastrophes - they are profoundly social events. The ways in which diseases are spread and treated are strongly influenced by larger sociological considerations, and they may have the capacity to change social institutions or society Itself. Rooting Aids In The History Of Diseases, The First Part Of The book reviews the nature, history and responses of earlier dreaded diseases. The next section examines AIDS itself, proposed as the archetypal dreaded disease. Already creating a sense of panic, AIDS is also shown to be a social disease, likely to have significant effects on the social order. Thus, only by containing the epidemic of fear and controlling the resulting irrationality, can the AIDS epidemic be halted.

PART I
NATURE, HISTORY, AND RESPONSES TO DREADED DISEASES

Chapter 1

CRISIS AND CONTAGION

And behold, a pale horse, and its rider’s name was death.

Revelation 6:8

THE GREAT EPIDEMICS: AN OVERVIEW

The Black Death or Bubonic Plague

The fourth horse of the apocalypse, the pale one, represents plague. For much of history, disease and epidemic were almost synonymous terms and dreaded for that very reason.

Historically, dreaded diseases have been of two types., The first type is the great epidemics. It is not hard to understand the great sense of dread surrounding epidemics that have swept through the world from time to time. The epidemics have included the great pandemics of bubonic plague (6th and 13th centuries, 1894–1902) and influenza (1918–1919) and the intermittent epidemics of these same diseases or other diseases such as yellow fever, typhus, typhoid, and cholera. The collective devastation of these diseases inspires awesome dread. For example, the mortality rate in Europe during the 1347–1350 epidemic of the plague has been estimated to be between 25 and 75% (Winslow, 1943). The 1894 epidemic of that disease killed more than 13 million eastern Europeans from 1918 to 1922. The influenza epidemic of 1918–1919 led to the loss of more than 700,000 lives. In Philadelphia alone, 12,162 people succumbed to influenza in the weeks between September 29 and November 2.

These mortality rates, overwhelming as they are, do not convey the social and corporate devastation that these diseases wrought. These diseases wiped out families and communities. They profoundly altered social institutions. They were epochal events that altered the very course of history. The bubonic plague provides many examples of this. The emphasis on judgmental theology that emerged from the plague’s Cult of Death later contributed to the reaction of the Protestant Reformation. The plague also provoked peasant revolts and widespread religious programs that set the stage for ghettoizing Jews (Tuchman, 1978), and social movements of self-flagellants challenged all principles of medieval order.

The bubonic plague would head most lists of these epidemic dreaded diseases. Bubonic plague has two forms. In the more common bubonic form, the infective bacterium (Pasteurella pestis, also known as Yersinia pestis) affects rats. The fleas carried by the rats can also feed on humans and are apt to do so when the rat population is decimated by disease. Hence, a rat epidemic usually precedes the human one.

The symptoms of plague usually begin with swollen lymph glands in the armpits, neck, and groin. The Greek word for groin, buboes, gave name to the plague. High temperatures, chills, and severe prostration follow the swelling. Death often comes rapidly, within a few days, generally due to septicemia and internal bleeding. It is estimated that in the early epidemics, perhaps between 60 and 90% of those infected died.

The other form of bubonic plague is pneumonic. This form was even more deadly than the bubonic form, with a mortality rate that, in the early years, was well over 90%. The disease progresses as follows: The person’s lungs are infected with the bacilli. The disease then can be spread directly from person to person, through spit or air droplets in an infected person’s breath. Often this variety has had a large role in major pandemics that have scourged humankind.

Like many early diseases, the roots of the plague are somewhat lost in historical mist. It is suspected that the disease may have emerged somewhere in Central Asia. Some have suggested that the plague of Thucydides may have been bubonic, although most historians believe it was more likely measles, typhus, or fungus ergotism (Marks & Beatty, 1976). In any case, as Marks (1976) concluded, that plague is difficult to identify. Others see bubonic plague as the Old Testament disease that destroyed the Philistines or ended Sennacherib’s siege of Jerusalem.

However, these early instances are unclear. It is generally accepted that bubonic plague was the plague of Justinian that swept through Europe and Asia in 541 A.D. Justinian, the Byzantine emperor at that time, was poised to reestablish Rome. He had established peace with Persia, his chief enemy, and his other enemies were divided and weak. He had recaptured Italy from the Ostrogoths and North Africa from the Vandals. The Mediterranean nations seemed to welcome the security and peace his empire could offer. Another era of “pax Romana” or a Byzantine peace seemed at hand. Ironically, it was likely that this very peace facilitated the plague. The peace reopened and extended trade routes through the East and West. Traders and soldiers now had even greater mobility. The changing social conditions allowed the plague the same mobility that would have been inhibited and constrained in a more fragmented world. The dream of a new pax Romana would give way to a new nightmare.

It is estimated that 50% of the population, perhaps as many as 100 million people, died (Marks & Beatty, 1976). In the half century of the disease, whole towns, villages, and even cities disappeared, some never to recover. Agriculture regressed to a subsistence level. Taxes ceased to be paid, diminishing a once full treasury. Large estates were distributed as salary to soldiers, establishing a new social order. A once nascent empire fell into decline, later allowing Egypt and Syria to slip into the Islamic orbit.

Beyond the end of a perhaps renewed empire, the disease influenced the course of history in other ways. It hastened the decline of Greek and Roman medicine, which seemed powerless to stop the epidemic. The ideas of medicine, emerging at the time, that disease was caused by pathogenic agents was discredited. Instead, it was accepted that the disease was divine punishment for heresy’s sin and vice. Which heresy was arguable. The emperor, Justinian, spared from the disease, became convinced that Roman theological perspective on the dual nature of Christ, both truly divine and human, was heretical. The Orthodox Roman Church blamed Justinian’s perspective that Christ was solely divine as the blasphemy that merited divine punishment. In any case, the plague spurred a populace away from medicine, which seemed so unhelpful, to the church, which would now minister to both body and soul.

Most pandemics, especially the bubonic plague, are self-limiting. Over time, the rat and human populations become too limited to provide a reservoir for the disease. Those who survive may develop total or partial immunity. In northern climates, the hibernation or death of fleas in winter breaks the cycle of transmission.

Thus, after close to 50 years, the plague of Justinian faded as a major health threat. But the plague struck again some eight centuries later. This is not atypical in great epidemics. In their rapid spread, whole populations are exposed to the disease. Many die, but those who are not infected or recover seem to have some immunity. The disease then wanes for lack of a host, perhaps to strike at some future time, when conditions are again favorable for the disease to spread.

Interestingly, the plague seemed to have disappeared from Europe for close to 500 years. Somehow, the transmission chain of rats and fleas and humans had been broken in Europe, though the plague maintained a reservoir in central Asia. McNeill (1976) suggested that the disease might have reemerged in China in 1331, killing as much as half the population (Garrett, 1994), perhaps spreading from Yünnan to Burma through Mongol travelers. From there it was carried to Europe through caravans, affecting both human and rodent conditions.

Social conditions were once again favorable to the spread of the disease. Trade and shipping dramatically increased for a number of reasons. Western naval forces had wrestled the Strait of Gibraltar from Moslem forces that had inhibited Christian ships. New designs in ships allowed safer travel. Unfortunately, rats too were exchanged in addition to goods. And the expanding trade led to increases in the population of the port cities. The growth of cities provided new ecological niches for rats and brought together high densities of people in unhygienic conditions. Bathing was considered unhealthy, fleas and lice a normal part of life. Sewer systems were nonexistent and primitive. Homes made with thatched roofs allowed nesting for rodents and other vermin. These developing urban areas then provided perfect opportunities for diseases to spread, especially one spread by flea-infected rats. Even efforts to contain the disease, such as burning homes of victims, were counterproductive because they simply drove infected rats to seek new shelter.

The plague’s initial entry into Europe seems to have been the more direct result of refugees. As reported by one disputed witness, the origins of the 14th century plague seem to have been a primitive form of bacterial warfare. During a siege of Kaffa, a Crimean city now called Theodosia or Feodosiya, the besieging Tartars were struck by a deadly disease. The corpses of these dead soldiers were catapulted into the city, spreading the disease and ending the siege. The survivors of the siege, as well as that of another infected city, fled by ship to other cities, thereby bringing plague in their wake. However dramatic this occurrence, the plague was able to continue to spread through trade routes.

From 1346 to 1361, it is estimated that more than 27 million people died. Most estimates are that 25–40% of the population was killed, although some estimates are even higher (McNeill, 1976; Winslow, 1943).

Again, in the absence of a credible science, the plague, at that point called “The Black Death,” was blamed on divine retribution. The disease was perceived as punishment, perhaps for sexual indiscretions or tolerating heresy. A call for a pilgrimage to Rome in 1348 by Pope Clement VI brought more than a million people to Rome, carrying disease as they traveled. Flagellants, religious devotees who whipped themselves for atonement, also marched in processions from town to town, bringing the disease with them. Other forms of obsessiveness, a dancing mania and a widespread cult of the dead, were also common. The disease also caused widespread persecution, most particularly of the Jews but also cripples and lepers. In fact Boswell (1980), in a history of homosexuality, considered the 12th century a tolerant one. Monarchs openly engaged in gay love affairs. Yet there was far less tolerance in the 13th and 14th centuries. There were a number of reasons for this, Boswell believes. The Crusades had heightened religious feelings. The development of nation states and absolute monarchies fed pressures for conformity. But the plague also played a role, buttressing a sense of divine retribution that made all minorities—Jews, lepers, cripples, heretics, and homosexuals—suspect.

The Black Death was an epochal event. Hourani (1991) viewed the plague as a significant factor in Islamic society, depopulating cities and reducing its agricultural base so that it was less prepared for Christian counterattacks that allowed the reconquest of Spain and Ottoman capture of the Islamic world. Others have debated its effects on the West. Some have seen the Black Death as contributing to an emergent individualism (Aires, 1987) and a decline of feudalism (Claster, 1982). It may have unwittingly set the stage for the Reformation, providing Catholicism with a serene judgmental theology that Luther, over a century later, would attack. In any case, it decimated the intellectual classes, particularly those in medicine and the clergy, who were on the caregiving forefront of the epidemic, and turned the philosophical optimism of the 13th century to a deepening sense of doom (A. M. Campbell, 1966).

Most historians believe that the Black Death was a bubonic plague, particularly its more virulent pneumonic form. In this disease, massive internal hemorrhaging caused a black discoloration that may have given the disease its name.¹ However, this perspective has been challenged by Twigg (1984), who argued that the rat-flea-human cycle could not account for the widespread course of the disease and its massive toll. He further suggested that the pneumonic form of the disease could exist only in certain conditions that were not widespread at the time. Twigg (1984) concluded that the Black Death was not the bubonic plague at all, but a form of anthrax.

Whether this epidemic was the bubonic plague or not, the bubonic plague returned in more localized outbreaks throughout the subsequent century. It struck England in 1665–1666, described by Defoe (1911) in his journal. There were varied epidemics in the Mediterranean countries and in Asia, including a serious outbreak in China in 1894. It even caused a scare when it appeared in San Francisco’s Chinatown in 1907.

The disease that at least once, perhaps twice or even more, shattered humankind, seems far less virulent now. Modern medicine has reduced the mortality rate to less than 10%, which was once the rate of survival. It is likely that the infecting bacteria evolved into a milder form. This is to be expected. Evolution favors strains that do not rapidly kill their hosts. Then, too, in the developed world, changes in transportation, housing, and lifestyle have reduced exposure to the rat-flea-human cycle typified by the plague. Unlike their earlier counterparts, people today no longer consider flea infestation a normal part of daily life. The emergence of the brown rat over the black rat, and the construction of stone and brick housing, mean that most humans no longer live in close proximity to rats. The brown rat, too, now tends to be infected by different fleas and is less prone to plague. New modes of transporting goods preclude the infestation typical of the overland routes by which our forebears traded.

Cholera

Although the bubonic plague ceased its scourge, at least in the West, other diseases captured that same sense of dread. Most certainly cholera did. Cholera is a bacterial infestation of the intestinal linings, causing continuous diarrhea, intermittent vomiting, and severe abdominal pain. If untreated, cholera can cause rapid death due to dehydration. Almost nonexistent now in the developed world, cholera, still common in developing nations, is caused by the bacterium Vibrio cholera, found in polluted waters or on raw fruit and vegetables. It is treated today with antibiotics. In most cases, victims are hospitalized and given fluids intravenously to prevent the rapid dehydration associated with the disease.

The current complacency about the disease, at least in the developed world, contrasts sharply with the sense of dread and devastation the disease provoked less than two centuries ago. As Rosenberg (1962) stated, “Cholera was the classic epidemic of the nineteenth century as Plague had been of the fourteenth” (p. 1). Cholera, too, seems an old disease. Marks and Beatty (1976) found some ambiguous references to cholera in India as early as 400 B.C., with other inferences around 1325 A.D. But he judges the first reliable reports identifying cholera, also from India, date it in 1768–1769.

Four major pandemics struck the world in rapid succession from 1817 through 1875, striking most sections of the world and killing perhaps as many as millions. Although the mortality rate was not as high as for other diseases (e.g., more Americans died of malaria or tuberculosis), it terrified the population because it was a new disease that both spread rapidly and killed quickly.

But it did not always strike all populations equally. As Dr. John Snow, a London physician, would show later in the pandemic, cholera existed where sanitation was poor. Hence the poor suffered disproportionately. And, as in AIDS, the victims were blamed for their fate.

The disease, which had been somewhat endemic in India, now spread to the rest of the world. Three things facilitated this movement. During this time, the British economic and military penetration of India provided opportunities for the disease to move beyond geographic boundaries. Sleek ships rather than plodding caravans could now rapidly spread the disease. Second, once the disease spread, it entered a world that was far more mobile. Migrations and movements of people hastened its spread. Moslem travelers spread it throughout the Moslem world when the disease struck during the 1831 pilgrimage to Mecca (McNeill, 1976) and Irish immigrants brought it to the New World. Third, cholera struck at a time of rapid industrialization and urbanization throughout the world. Public sanitation, water, and sewer systems were nonexistent in many urban areas. This gave ample opportunity for the bacteria to spread.

Because the disease disproportionately struck the poor, it fanned class resentments and hatred. As with HIV, many of those infected with the disease, or at least those at risk, suspected the authorities of either developing the disease or facilitating its spread. In Poland and other parts of Eastern Europe, physicians, already poorly regarded by peasants, were suspected of poisoning the poor to kill off a surplus population. In Paris too, the poor saw the aristocracy as seeking to poison the poor. In the United States it was the poorer urban classes, particularly the Irish and Blacks, that suffered from the “poor man’s plague.” Although the Roman Catholic priesthood received some respect and sympathy for ministering ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Foreword
• Preface
• Acknowledgments
• Part I Nature, History, and Responses to Dreaded Diseases
• Part II AIDS: The Archetype of the Dreaded Diseases
• Bibliography
• Index