As with all eleventh-grade students of New York, I had the distinct pleasure of sitting for the Regents examination in Global History. Without giving myself airs, I’ve had the happy fortune of cultivating a perpetual curiosity about the world, and – even without much guided academic study – was capable of answering most any question simply based on my background knowledge gleaned from years of independent study (at a later date, I’ll discuss my thoughts on my education). The format of the exam, for those of you unfamiliar, is a series of multiple-choice questions, and two essay prompts. One of my essays asked me to discuss a time in history in which mankind exerted influence (for its own benefit) over his environment. I actually struggled with this question, as I could think of many of examples (Roman aqueducts, for instance), but couldn’t provide any sort of intellectual exploration for any of them that would span more than a few paragraphs.
John Snow Memorial and Pump (Soho, London)
And then, eureka! The Cholera outbreak in London (1853-4) and the Broad Street Pump in Soho sprang to my mind. I’d read about it many times when I was significantly younger, and could easily regurgitate the necessary facts: Dr John Snow, the ‘father of epidemiology,’ tracked – on a now-famous map – the cases of cholera around Soho, in London. By physically representing the cases (with pins), he was able to visualize from whence the disease originated. In a fit of mighty altruism, he broke the handle of the pump and effectively stopped the outbreak. Of course, the cholera bacterium hadn’t yet been physically identified, but its vessel of transmission (water) worked well enough: preventing the consumption of contaminated water by the population was effective in derailing the epidemic.
(For those of you keeping track, my mid-examination brain eruption had a rather happy outcome: I received a 98%, and was told by the grader that he’d never heard of the event, didn’t quite believe what I was writing, and therefore resorted to his own independent research).
Suffice to say, it was the esteemed Dr. J. Snow I recalled, then, when I first began following the Swine Flu Outbreak of 2009: the same underlying forces were at work (figuring out the origination and mechanism by which an illness was spreading), though the flu has a more striking, sudden relevancy. Globalization, obviously a virtually non-existent issue during Snow’s tenure, has created a paradigm shift in the management, prevention, understanding, and study of community health issues. Though it’s an admittedly sensationalistic piece, H. Markel (author of the book When Germs Travel) evaluates the undeniably dangerous aspect of globalization and its effect on public health: since symptoms for illness usually take a few days to manifest, one need only board a plane (making available some 200-odd individuals, breathing re-circulated air for (on an international flight) hours), enter an airport (a busy terminal thronged with others, who are usually also boarding a plane), stumble through a metropolis (presuming the airport is in or around a city), and – finally – arrive back at one’s humble abode. In every stage of the process, pathological transmission rates can easily and rapidly spread; global illness movement, a process that formerly would take weeks, months, or years, is accomplished in hours.
Understandably, then, it’s all a rather frightening turn of events. Even if this H1N1 Swine flu subtype isn’t, in and of itself, particularly threatening, it is a gentle reminder of the fragility, and inherent consequences, of modern society. Evolution favors viral diseases that have a reasonably lengthy incubation period (thus allowing transmission to many people); modernity facilitates the transmission of pathogens around the globe far better than any other mechanism in history. The fundamental connectedness experienced the world-over is a treacherous situation. What’s left in the wake of any outbreak currently, then, is a mad scramble to pinpoint, track, and understand the progress of an illness: for each and every potential pandemic is the moral imperative to treat the sickness as as a most-deadly, most-transmissable strain. By the time the true nature of the malady is understood, it could (painfully easily) be ‘too late.’ Public health coordinators are left vying for public attention without dousing the world community’s fire with gasoline: the severity and seriousness of the issue has to be impressed upon a [frequently un]willing populace, while still avoiding the triggering of panic.
A Cholera Notice
It’s like a germy, agar-soaked version of Peter and the Wolf, one could suppose. Perhaps when a devastating outbreak occurs, we (as a collective whole) will have been so jaded by all of the other ‘not-quites’ ‘nearlys’ and ‘almosts’ that we will continue to not wash our hands, sneeze on doorknobs, lick urinals, and engage in whatever other strange and bizarre human rituals members of society deems [un]acceptable. The hubris of modern man is astounding and limitless, and it wouldn’t come as any surprise (at least to myself) if such a characteristic is the fundamental root of our demise: complacency can, obviously, breed terrible things. And in the case of public health, the complacency of one can have reverberating implications for the global community.
Public health, within a sociological framework, has long held my fascination. There were a couple of years when (during my oft-shifting educational and professional desires) I was seriously considering medical school; this interest slid into a desire to study, more or less, public health. And finally, after taking a number of courses in the sociology of medicine and medical anthropology, I was all but certain that I would pursue a medicine and society doctorate. What initiated this interest was, as with most of my interests, a book: The Spirit Catches You and You Fall Down by A. Fadiman (I really cannot recommend this book strongly enough; it is a fantastically compassionate and human study of cultural conflict and the consolidation of divergent medical practices. An aside: I had the undue pleasure of meeting the author, who so graciously signed my copy of her book). The integration of Western medical tradition into non-Western societies and cultures remained a pervasively interesting subject for me, as did the methodology of different groups of people (historically and contemporarily) for managing illness. A prime example of this is the Guinea Worm outbreaks in developing nations (the Times ran an outstanding article a couple years back, available for your perusal, entitled ‘A Dose of Tenacity Wears Down a Horrific Disease’) and international attempts to eradicate infection and transmission.
Over the years, I’ve winnowed my way through the [sub]genre of medical sociology, and read an increasing number of books on what it means to be a doctor, the medical mindset, medical history, and theories and sociological underpinnings of community health. As an abstraction, though not as an actual applicable profession, I was enraptured.
As one final aside, I cannot recommend strongly enough that one explore Wikipedia’s take on CDC Pandemic Severity
CDC Pandemic Severity Index Scheme
Index Scheme. It’s a well-reasoned chart until the ‘Level 7,’ at which point one may as well lose all faith in humanity. I’ve reproduced it here, for posterity’s sake. ‘CFR’ is an acronym for ‘Case Fatality Ratio’ (who, among those infected, will die from the illness). I’m loathe to publicly proclaim my suspicion that this Swine Flu outbreak is not the eschaton (though, I hold out hope that I may be fortunate enough to hear the four horsemen thundering through the streets!).
Humbly-Recommended Reading List and [If Applicable] Accompanying Commentary:
I. Complications: A Surgeons Notes on an Imperfect Science – A. Gawande
II. The Spirit Catches You and You Fall Down – A. Fadiman
III. When Germs Travel: Six Major Epidemics that Have Invaded America and the Fears They Have Unleased – H. Markel
IV. Kill as Few Patients as Possible: And Fifty-Six Other Essays on How to Be the World’s Best Doctor – O. London (A truly fantastic collection of essays exploring the role, mindset, motivation, and achievements of medical practice)
V. The Great Influenza: The Story of the Deadliest Pandemic in History – J. Barry
IV. Man and Microbes: Disease and Plagues in History and Modern Times – A. Karlen
