ASSAY: A JOURNAL OF NONFICTION STUDIES
In The Gospel of Germs, Nancy Tomes opens her discussion in 1884 New York at the elegant home of Martha Roosevelt, mother of future president Theodore Roosevelt, as Martha succumbs to typhoid fever (Tomes 23). Tomes then takes the reader through a scientific history of germ theory, its architects, and the transition from a healthcare philosophy where physicians’ conclusions were based on observations of illness in the individual and the community to one where determinations are made based on evidence discovered in a laboratory (28).
Priscilla Wald also begins with a scene of disease in Contagious: Cultures, Carriers, and the Outbreak Narrative, but this one is from Wolfgang Petersen’s 1995 film Outbreak, based on Richard Preston’s 1994 nonfiction book The Hot Zone—a bestselling story about the origins and movements of viral hemorrhagic fevers, particularly Ebolavirus (Wald 29). Wald goes on to reference numerous books, films, articles, and essays that form an archive of American disease narratives.
From these initial pages, it is evident that Tomes is interested in how ideas around disease impact individuals as they go about their everyday lives, while Wald is interested in how disease narratives are framed in popular culture and entertainment. However, these two works converge in several places, specifically and I believe most significantly, around the effects of Americanism on public health discourse and disease narratives, the role of gender in portrayals of proliferation and prevention of environmental conditions that lead to infection, and the commercialization of contagion for economic profit. Priscilla Wald and Nancy Tomes both skillfully explore the intersection of public health and popular culture in their respective books on America’s relationship with infectious disease and contagion. Though they begin at different places on the continuum and direct their focus on different themes, these two texts identify overlapping ideas that are critical to our understanding of how disease narratives are formed and perpetuated in various mediums and genres. Namely, they both illustrate that in almost every major public health crisis to affect the U.S., a prevailing narrative emerged that blamed people—not pathogens—for the devastation, and that blame was consistently targeted at racial, ethnic, and/or sexual minority groups in what Wald describes as a “moral contagion” response (Wald 114).
I revisited the impressive work of these scholars two years into the most devastating pandemic in U.S. history—a public health crisis that further exposed the deep-seated racial, ethnic, and gender inequities of America in a way that, as Priscilla Wald and Nancy Tomes have shown, only a widespread and deadly communicable disease can. I reflected on disparities in healthcare access that resulted in disproportionate disease and death among Black, Brown, and poor communities, and I ruminated on the consequences of inconsistent messaging and political partisanship at the federal, state, and local levels (Noppert; Chen and Karim). It was impossible to ignore the repetition of histories that Wald and Tomes so effectively describe in their respective books. If public health narratives were tied to Cold War politics in the 1950s, as Wald asserts, then the viral rhetoric of the last three years was certainly tied to U.S.-China trade war politics. And if the urban poor bore both the brunt and the blame for tuberculosis spread at the turn of the twentieth century, as Tomes argues, so too were low-income city dwellers situated at the epicenter of the Covid-19 outbreak over 100 years later.
Neither Priscilla Wald nor Nancy Tomes could have predicted the arrival of a novel coronavirus that would kill millions around the globe in their lifetimes, but their scholarship and commentaries are exceedingly relevant after this catastrophic event. Stories have the power to intensify or help mitigate health inequities that currently exist as well as future disparities that will be created due to conditions like climate change and forced environmental displacement and migration. Public health narratives address life-or-death scenarios, both then and now. Whether we’re writing an essay for a health-related journal, crafting a longer work exploring the origins and impact of a specific condition, or attempting to forecast and mitigate future crises such as the health consequences that may arise from global warming, it is essential that we familiarize ourselves with the content and context of past disease narratives so we're able to better identify and counter misconceptions that may emerge in our own or our students’ work. In an essay published at the outset of the Covid-19 crisis in 2020, culture critic Soraya Nadia McDonald writes, “In American epidemics, race is a preexisting condition” (McDonald). In disease narratives, so is ethnicity and nationality. Priscilla Wald provides an explanation of this marriage between public health and American nationalism in the third chapter of Contagious titled, “Communicable Americanism: Social Contagion and Urban Spaces.” She writes,
The public health movement gained momentum as the century progressed; epidemics of communicable disease fueled the movement and called attention to the dangerous conditions of the spaces of urban poverty. The particular association of those spaces with immigrants in the United States intensified nativism by materializing and amplifying the fear of communicable-disease epidemics imported by immigrants and bred by the squalor of the tenements. (Wald 115)
Wald references important historical and cultural works, including social reformer and journalist Jacob Riis’s groundbreaking photography of urban poverty in the late nineteenth century and his associated book How the Other Half Lives, American writer Joaquin Miller’s 1886 novel The Destruction of Gotham, various articles from early issues of the American Journal of Sociology, and the writings of one of the founding fathers of the sociology discipline—Robert E. Park (114-117). Wald dissects Park’s influential 1915 essay “The City: Suggestions for the Investigation of Human Behavior in the Urban Environment” and notes that his interpolation of the term “social contagion” alongside “communication” is essential to the emerging theoretical pathway Park was developing. Wald explains, “his use of social contagion in the essay illustrates the difference between sociology and social reform. It also demonstrates the commingling of biological and sociological theories about contagion that would become foundational for the outbreak narrative” (116). Through her analysis of these sources, Wald offers compelling evidence that the American public health system was formed as a response to a “moral contagion” as much as it was designed to combat a biological threat, and that the idea of “social contagion” helped birth the academic discipline of sociology—specifically, the field of urban studies (114-142).
Nancy Tomes reinforces this point in the introduction of Gospel of Germs. She writes, “For many middle-class Americans in the early 1900s, the association of poor, immigrant, and non-white citizens with disease germs only deepened their feelings of class prejudice, nativism, and racism” (Tomes 11). Invoking Biblical metaphor, she continues, “By harping on the menace of contagion, the apostles of the germ inevitably increased the stigmatization of the sick and the poor. The specter of infection served nativists and racists well in their efforts to legitimate immigration restrictions and racial segregation” (11). She expounds this idea in Chapter 8 of The Gospel of Germs titled, “The Wages of Dirt Were Death.” Tomes explains that “germ” had become a household word by the early 1900s, but this awareness was limited mostly to affluent, native-born families and the domestic help who attended to their needs (183). She writes,
At a time when the ‘antisepticonscious’ middle class was purchasing SyClo toilets and buying vacuum cleaners, many Americans still lived in households lacking running water and flush toilets. By the eve of World War I, the awareness of germ dangers and the practice of antiseptic cleanliness had come sharply to differentiate rich from poor, literate from illiterate, native from foreign-born, and urbanite from rural-dweller. (183)
Tomes uses tuberculosis as an example of a disease thought to affect every class in the nineteenth century, but which, by the early twentieth century, became more associated with the poor, ultimately losing its identity as a “house disease” and becoming a “tenement house disease” (184). Even in 1884, when Martha Roosevelt was on her deathbed, typhoid was linked to uncleanliness, and the Roosevelt home was kept immaculate to combat it. No one understood then that Mrs. Roosevelt could have contracted the disease while socializing outside her home by eating contaminated food or coming into contact with an asymptomatic carrier (23-25). However, only a couple of decades after Martha Roosevelt’s death, America’s larger cities were sharply segregated by class and race, with disease mortality rates and sanitary conditions between neighborhoods alarmingly disparate (185). These inequities prompted an onslaught of “hygiene reformers” who set out to teach the tenets of household disease prevention to the urban poor, namely immigrant mothers and their daughters.
The poorest neighborhoods had little or no public services like filtered water supplies and municipal sewer systems. Landlords often kept the tenements in ill repair and many of them still only offered outdoor privies rather than indoor bathroom facilities, but reformers believed that despite the lack of these basic public services, there were still measures that could be taken to minimize contagion (185). This reform work was done by women and directed toward women. Tomes notes that though these endeavors were strongly supported by the male public health establishment, “the gospel of germs was preached primarily by female professionals. During the first three decades of the century, countless women visiting nurses, social workers, and home economists went as sanitary missionaries to working-class and farm households” (184). However, their sanitation lessons often came with inherent ethnic and racial biases and collided with cultural traditions that immigrant women were resistant to forfeit.
The hygiene reformers were aided in their mission by municipal public health departments and a slew of reform-minded organizations that emerged in the Progressive Era, including the Young Men’s and Young Women’s Christian Associations, visiting nurse associations, immigrant aid societies, child welfare groups, and public schools. Insurance companies also distributed health information and hired nurses to instruct their working-class policyholders on methods of disease prevention (186). However, there may have been no one who affected the way Americans thought about disease in the early twentieth century more than “Typhoid Mary” Mallon. Her story and that of the man who identified her as an asymptomatic superspreader is the foundation on which Priscilla Wald explores gender roles in disease prevention and proliferation within the contagion narrative.
The theory that communicable diseases could be spread by otherwise healthy persons was a new and controversial concept in the early 1900s (Wald 68). No one had proven that such an asymptomatic carrier existed until an employee with the U.S. Army Sanitary Corps, a doctor named George A. Soper, performed some impressive investigative work to identify what he called a “chronic typhoid germ distributor” (Soper). The culprit was Mary Mallon, an Irish immigrant who routinely worked as a cook for both private families and larger organizations. As evidence of the impact of this discovery on epidemiology in the early twentieth century and its continued importance today, Wald dedicates an entire chapter of Contagious to the notion of the “healthy carrier,” and it’s clear that she believes George Soper is a sort of founding father of the “patient zero” story structure that we see in so many modern books and films. She writes, “Soper was a masterful storyteller, and the early accounts of his discovery conspicuously present his epidemiological investigations as narratives of detection” (Wald 68).
Due to Mary Mallon’s reported refusal to cooperate with public health officials, she was forcibly committed to a contagious hospital, where her bodily excretions could be collected and examined. She fought this detainment in the courts, a move that resulted in a public legal drama—another theme we often see in modern disease narratives. Mallon lost the appeal and was deemed a menace to public health, but, Wald explains, an administration change a few years later led to Mallon’s release with the conditions that she give up her profession as a cook and check-in with the department of public health on a regular basis. Instead, Mallon assumed an alias and disappeared. When she was rediscovered in 1915, George Soper’s version of Mallon’s willful disobedience and endangerment to society dominated the newspaper accounts, leading to a loss of any public sympathy that Mallon once enjoyed and earning her the moniker “Typhoid Mary” (69). The effects of this series of events on public health policy, scientific and epidemiologic investigation, and nonfiction disease narratives, as well as fictional accounts, cannot be understated. Not only did the “Typhoid Mary” story forever associate uncontrolled disease spread with a woman and an immigrant, but it further solidified in the public consciousness the idea that women, in their traditional gendered roles of cook, housekeeper, childcare provider, nurse, and teacher, bore the responsibility of disease prevention and shouldered the guilt if their efforts failed to contain an outbreak.
Wald goes on to make an important connection with another “moral contagion” that was ever-present in nineteenth and twentieth century public consciousness: venereal disease. She writes,
Hints of venereal contagion permeated the accounts of the carrier cook, and they registered the power of that imagery at the turn of the twentieth century. Venereal disease evoked social as well as medical anxieties. From the medical to the popular press, religious treatises to popular fiction, discussions of venereal disease addressed the transformations in the structure and function of families and the gender roles they reproduced that resulted from the pressures of urbanization and industrialization. These discussions typically worked to negotiate changes in familial and social structure by linking changing gender roles and sexual mores to the fate of the white race and therefore to the security of the nation. And they inflected the emergent story of “Typhoid Mary.” (71)
While George Soper was tracking down Mary Mallon, there was a steady stream of articles published in medical journals about the physical and social dangers of extramarital sex, with a consistent subtext implying a threat to the perpetuation of the native-born, white race, in particular. Wald focuses on the work of Albert Morrow, a dermatologist who became one of the foremost publicists on syphilis and its consequences. She quotes an essay of his from the American Journal of Sociology, in which he discusses how the disease corrupts marriage, an institution that exists “for the purpose of regularizing sexual relations between men and women, and the creation, care, and maintenance of children…—not offspring merely, but children born in conditions of vitality, health, and physical vigor, and capable of becoming useful citizens to the state” (Morrow 87). The “useful citizen” category that Morrow refers to is reserved for the white middle and upper classes (Wald 88). Though prostitution was an obvious target, there is a thinly veiled warning in Morrow’s essay against the trend toward increased female agency, in general. Wald explains, “More typical than Wolfe’s proposal were the calls for greater moral standardization of women that issued from the pages of academic and medical journals as well as the pulpit and the popular press. The implicit threat of venereal disease often colored these discussions of female mobility, giving form to the unnamed danger associated with social change” (89).
Nancy Tomes also refers to Albert Morrow’s work in The Gospel of Germs, in addition to the work of several other dermatologists who were studying the characteristic sores that those with syphilis often suffered from. Though Tomes frames her discussion around the perceived threats of industrialization and the unsanitary conditions in the workplace, these fears also contain an undercurrent of racism, xenophobia, sexism, and classism. Tomes writes,
From the middle-class consumers’ standpoint, the health status of industrial workers mattered little, as long as the products they made did not convey disease into the home. But many of the most important new sectors of mass production were domestic goods, including clothing and food, that public health doctrine now emphasized as potential carriers of contagious diseases. The image of a consumptive seamstress stitching a baby’s nightgown, or a tuberculosis cow producing milk for the dairy, suddenly made the connections among diseased work places, sick workers, and American homes real and frightening. (Tomes 109)
This was problematic because the middle-class consumer wanted these products. They enjoyed the commercial entertainments and services that Progressive-era cities and towns offered. From shopping in department stores to dining in restaurants to attending plays and visiting amusement parks and dance halls, Americans were embracing a more modern way of living. Tomes writes, “however much they may have wanted to, affluent white Americans could not seal themselves off from the potentially disease-ridden transactions of everyday life. Participating in the pleasures of a mass consumer society, whether by buying a new dress or eating out at a restaurant, involved a certain level of risk” (111-112). Tomes explains that two movements took hold during this time period as a means to mitigate the microbial threats of modern life: the antituberculosis crusade and the domestic science movement (112).
In Chapter 5 of The Gospel of Germs, aptly titled, “Tuberculosis Religion,” Tomes describes the aggressive campaign in the late nineteenth and early twentieth centuries to educate the American public on the communicable nature of consumption and train them on how to thwart the spread of the disease. This mission employed the zealous language and methods of evangelism. Tomes writes,
The anti-TB societies mounted the first truly mass health education campaign directed at a single disease. Working closely with city and state departments of health, they produced countless lectures, exhibits, posters, films, and pamphlets that preached to millions of Americans from all walks of life the same hygienic message: tuberculosis was a deadly communicable disease that could be prevented by careful hygiene. In the process, the anti-TB movement profoundly changed individual conceptions of public health morality—that is, the responsibilities that ordinary people should assume in order to guard themselves and others against infection. (114-115)
Tomes explains that the anti-TB movement initially relied on traditional forms of persuasion, including pamphlets, lectures, and newspaper articles. However, when the TB crusaders realized that they were not reaching the groups deemed “most in need of instruction”—those in the lower classes with little education—they looked to the growing field of advertising (116-117). Tomes notes, “For public health educators, these new advertising methods represented a veritable gold mine of persuasive techniques” and provided new methods to illustrate the invisible (117). These early attempts relied heavily on the “reason why” strategies and heavy-handed parental-style admonitions that were popular advertising approaches of the time, but further into the twentieth century the anti-TB movement took a lighter approach and turned to popular entertainment as a way to inform the public. In 1910, the National Tuberculosis Association (NTA) commissioned Thomas Edison to produce a series of films for the cause (121). These movies that combined information with entertainment proved extremely popular and pioneered a new relationship among information dissemination, visual culture, entertainment, and advertising.
Charles De Forest, director of the NTA’s Christmas seal campaign, came up with the revolutionary idea of enlisting children in the anti-TB mission. Utilizing a timely interest in medievalism, he created a sort of game with different levels that children could reach based on their sales of Christmas seals—from squire to knight to a seat at the “round table of health chivalry.” Tomes notes, “By 1922, over 7 million American children were enrolled as participants in the crusade” (120-123).
As anti-TB organizations were employing persuasive tactics adapted to the new consumer economy, using Protestant evangelical language around the moral obligation to prevent disease spread and focusing on the home as the primary site of infection, another movement was developing in parallel—the domestic science movement. Though anti-TB crusaders were united in their mission to lower the rate of disease across all communities, Tomes notes that they “disagreed over whether individual behavior, hereditary defect, or environmental conditions were most to blame” for variable rates of disease incidence among different racial and ethnic groups (129). She references a 1905 lecture on the “Home in Its Relation to the Tuberculosis Problem,” given by Johns Hopkins physician William Osler. During the talk, Osler displayed a chart comparing the “personal and household cleanliness” of tuberculosis patients treated at a Baltimore Clinic. Tomes explains, “The chart purportedly showed that 70 percent of Russian Jewish homes, 56 percent of ‘colored’ homes, and 30 percent of the ‘white’ homes were not clean” (129). She notes that Osler’s chart also listed other factors, such as “bad sanitary locations,” “insufficient light and ventilation,” and “overcrowding,” that were out of the control of those who lived in poor neighborhoods, but the “uncleanliness” narrative fed into existing prejudices against non-whites, not the least of which was the characterization of the “other” as “dirty and dangerous” (129-130).
The domestic science movement and the women reformers focused on what was within the control of housewives and families. Tomes quotes Marion Talbot, one of the leaders of the movement: “A knowledge of sanitary principles should be regarded as an essential part of every woman’s education, and obedience to sanitary laws should be ranked, as it was in the Mosaic Code, as a religious duty” (Richards and Talbot 135). The domestic science movement complemented and expanded on the work of the anti-TB crusaders, declaring the home an infection site not only of TB but also of all germ-related illnesses, including typhoid, diphtheria, and food poisoning. Though these “domestic scientists” often struggled to convince an older female generation of the importance of modernizing the American home, a younger generation of women who’d enjoyed access to higher education at women’s colleges quickly proved to be a receptive audience. Marion Talbot earned a B.A. from Boston University in 1880 followed by a B.S. from the Massachusetts Institute of Technology. She was hired to teach sanitary science by the University of Chicago in 1892, where she used her education and influence to share the “lessons of the laboratory” with other women who would then bring those ideas into their own American households (Tomes 136-138).
Thanks in part to the popularity of new women’s magazines like Ladies’ Home Journal and Good Housekeeping, the domestic science movement experienced great success. Soon, domestic science classes were a requirement for girls in public school systems, and women’s social clubs routinely offered domestic science programs. Spinoff consumer columns and reports, such as the “Good Housekeeping Institute,” emerged, and advertisements within these periodicals reinforced lessons in the “science of controllable environment” (140-141). Tomes notes that the intent of much of this early advertising seems focused on education, but adds, “Yet for all their appeals to science, manufacturers and advertisers did not promote the lessons of the laboratory for their own sake, but rather to sell products. When the two goals came into conflict, profit clearly won out (162). SyClo toilets were advertised as an appliance that made it absolutely impossible for germs to work their way into the home through water seals and pipes. Porcelain bathroom fixtures were marketed as the most sanitary option because their non-porous surfaces would not allow dirt to settle in, and water filter advertisements suggested that their product was the answer to the threat of cholera and diphtheria. Commercial disinfectants were marketed as far superior to soap and water in the mission of keeping a germ-free home, and vacuum cleaner manufacturers exploited the dust theory of infection (162-166). These messages continued through every room in the house and extended to the groceries brought into the home from markets and milkmen, as well as to the surfaces, spaces, and food one encountered outside the home when enjoying entertainment or travel (166-182).
In Contagious, Priscilla Wald focuses not on the connection between public health and consumer products, but rather on the marketability of political ideologies that germ theory instigated. In Chapter 4 titled, “Viral Cultures: Microbes and Politics in the Cold War,” she explores a transformation in the language American media used to describe viral contagion that suggests a relationship between disease narratives and Cold War politics. She writes, “As viruses became increasingly sinister and wily, sneaking into cells and assuming control of their mechanisms, external agents, such as Communists, became viral, threatening to disrupt the dissemination of information as they infiltrated the nerve center of the state” (Wald 158-159). This threat did not require a disinfectant spray or a new kitchen appliance; to defeat this enemy, the American people needed heroic patriots. Wald cites Jack Finney’s 1955 bestselling novel The Body Snatchers as a particularly poignant symbol of this comingling of disease and politics. She writes, “Finney’s story brought monstruous aliens to medical science and the language of virology into a battle for the survival of the human race…. The Body Snatchers arguably produced a subgenre, epidemiological horror, that depicted the transformative power of disease and groups” (160). Just as tuberculosis and typhoid drained the physical lives of loved ones in the nineteenth century, “With the pod people, Finney captured the horror of a protagonist’s dawning awareness that the humanity of his or her closest associates is being drained from them and the terrifying estrangement—as [German sociologist] Georg Simmel used the term—that results as they try to maintain their human connections” (160).
Wald connects the resurgence of contagion anxieties with the troubling realities of post-war America, including fears of Communist infiltration and nuclear warfare. She references the argument of Kirsten Ostherr, Professor of English at Rice University and author of the book Cinematic Prophylaxis: Globalization and Contagion in the Discourse of World Health, that “the mingling of anti-communism and homophobia with the ‘imagery and anxieties of world health’ manifests their shared concerns with a distrust of appearances, a fear of border crossings, and a lack of faith in the possibilities of detection” (Ostherr 139). This theme is reminiscent of the anti-TB movement’s messaging that Tomes discusses in The Gospel of Germs, which warns the population that they cannot trust what they see—just because something looks clean, invisible microbes may be lurking on any surface, just waiting to make them, their loved ones, and their neighbors sick (Tomes 165). Wald discusses subsequent versions of Invasion of the Body Snatchers and notes that they “illustrate the evolution of the epidemiological horror story and its conventions, notably in the pod people, the sinister, crafty incarnated virus that could be identified and fought in a mythic battle between Science and Nature….” (Wald 161).
Although the language of mid-twentieth century literature, amidst Cold War fears of communist infiltration and nuclear devastation, invoked earlier nineteenth-century connections of disease and invasion narratives targeted toward immigrants and the poor, both Wald and Tomes make compelling arguments that it is not until the AIDS epidemic that we see a full revival of fear-based responses to biological threats that mimic the mania of the anti-TB and domestic science movements. With the discovery of antibiotics and the development of vaccines in the first half of the twentieth century, Americans became much less fearful of infectious diseases (Tomes 252-254). Tomes notes that by the 1960s young physicians were advised against specializing in infectious disease and were encouraged to study cancer and heart disease instead. Infectious disease was no longer considered a threat (254). But when a new virus emerged in the 1980s, the full force of fear-based disease philosophies originally introduced by the gospel of germs were resurrected. Tomes invokes the story of Ryan White, a middle-schooler who contracted HIV through a blood transfusion, and the subsequent intense harassment he and his family were subjected to despite public health officials asserting that no one could get AIDS from casual contact. People would not share spaces with Ryan; rumors were spread that he was intentionally contaminating the food at the grocery store; some blamed his illness on his mother’s failure to keep her house clean; and a bullet was fired through the Whites’ home when Ryan insisted on returning to school (256).
In Contagious, Wald identifies two significant factors that led to the suspicious, fearful environment that Ryan White was forced to navigate. First, the earlier declaration that communicable disease was no longer a threat had led to a shortage of skilled researchers in the field, which presumably delayed accurate information dissemination on HIV (Wald 214). The second is what Wald describes as “the fantasy of the transformative nature of devastating viruses, a fantasy that emerged from the conventions through which viruses were explained to the public. Implicit in those conventions was the monstrosity of the infected and their willful perpetuation of infection” (213). These conventions led to French Canadian airline steward Gaetan Dugas being identified as “Patient Zero” of the HIV epidemic in the U.S. Wald writes, “The transformation of Gaetan Dugas into ‘Patient Zero’ represented the animation of the virus, which, like the converted pod people, loosed the specter of a willful scourge” (215). She argues that defining “Patient Zero” as an “AIDS carrier” in an effort to make sense of HIV/AIDS invokes the language and tone of earlier narratives, both real and imagined, including the story of “Typhoid Mary” and The Invasion of the Body Snatchers (215). She goes on to say, “Stigmatizing is a form of isolating and containing a problem, such as a devastating epidemic. It is also a means of restoring agency—which, as in the rumors of willful infectors, melts into intentionality—in the face of the utter banality of the foe. Nothing better illustrated the strategy or the scientific, medical, and social consequences than the fate of Gaetan Dugas” (226). Given that, for most Americans, Mary Mallon’s entire legacy rests on the perception of her as a “willful infector,” I would argue that she, too, personifies this idea.
Both Priscilla Wald and Nancy Tomes share a similar hope in their respective epilogues. Wald seeks an evolution of the outbreak narrative that tells the story of disease emergence and human connection in terms of social justice rather than of susceptibility. She writes,
Communicable diseases are a part of life; they will continue to emerge and circulate, and people will suffer and die. Yet suffering and death should not be accepted as inevitable in one place and unthinkable in another…. The emerging stories can exacerbate or begin to address the inequities. They can make a difference. It is not only possible but time to change the stories and the world they imagine. (270)
Tomes accordingly advocates for a public health system that better serves all Americans. She writes,
As we begin a new century, we face many serious challenges in the control of infectious disease, both in the United States and around the world. We are struggling to become more aware of the health consequences of our increasingly irreversible effects on the global environment, to balance the strengths and weaknesses of modern medicine, and to reverse race and class prejudices that sap the foundations of public health. I believe that the historical failures and successes of the gospel of germs have some valuable insights to offer as we fight those good fights. (Tomes 267)
As the world emerges from the Covid-19 pandemic, we are given yet another opportunity to evaluate how a devastating public health crisis was discussed in all forms of media—the stories that were told, who was telling them, and what their motives may have been. Inevitably, themes related to the pain, suffering, and profound loss this virus left in its wake will appear in creative writing texts for years to come. It’s imperative that nonfiction writers consider the public health histories of the past as they begin to shape the next chapters in the canon of disease narratives.
Amy Mackin writes at the intersection of media, science, cultural history, and social equity. Her criticism and creative nonfiction have appeared in The Washington Post, The Atlantic, Witness, AWP Writer’s Chronicle, Coffin Bell, Vineyard Literary, and elsewhere. She holds an MA in American Studies from the University of Massachusetts and an MFA in Creative Writing from Vermont College of Fine Arts. When she’s not engaged in independent research and writing, Mackin serves as the Manager of Communications and Outreach in the Population Studies and Training Center at Brown University.