Epidemics in Literature

The way we react to existential threats says a lot about the strength of human societies. Straw Dogs author John Gray believes that catastrophes reveal the true, savage nature of humanity, after the veneers of civilisation have been swept away by war or disease. These inclinations are demonstrated by waves of religious persecution which often followed outbreaks of disease in medieval Europe. Others, such as Camus, point to individual acts of solidarity and resistance which can characterise our responses. Epidemic diseases can also play a role in shaping the way society is run. For example, the enormous death toll of the fourteenth century Black Death resulted in a scarcity of labour which led to the mass movement of workers from rural areas to the cities, and the downfall of the feudal system.

Epidemic diseases are often seen in sci-fi and fantasy novels (William Burroughs’ late novella The Ghost of Chance includes a particularly dazzling array of diseases, such as one which causes people to believe they have the powers of Jesus Christ, and another which prompts uncontrollable hair growth), but there are also examples of authors taking on real-life epidemics in their work. Here, I’ve looked at a few cases, and compared them with historical and scientific accounts (trigger warning – some of them are a bit grim). 

Sweating Sickness

Hilary Mantel’s Booker-winning Wolf Hall was noted for the author’s attention to detail, and it’s no surprise that she included a strong account of the sweating sickness, a mysterious disease which plagued Tudor England. In fact, the disease was specifically linked to Tudor rule, the first reported incidences coinciding with the beginning of Henry VII’s reign. Later, it is thought that Prince Arthur succumbed to the disease, setting in motion the events which form the main body of Mantel’s novel, as the young Prince Henry married his deceased brother’s widow, only to have the marriage annulled when she failed to produce a male heir, prompting England’s split with Rome.

The true cause of the sickness is unknown to this day. Relapsing fever and hantavirus pulmonary syndrome have been suggested, but their symptoms and methods of transmission are not entirely compatible. Likewise, malaria was a possibility, but doesn’t act with the terrifying speed of the sweating sickness. The disease recurred throughout the sixteenth century, with a particularly virulent outbreak occurring in 1528, before disappearing after 1578.

In Wolf Hall, Thomas Cromwell’s wife and children succumb to the sickness. When Cromwell leaves his wife in the morning, she is sleeping but seems ‘warm and flushed,’ and the sheets are damp. By the time he returns in the evening, the house is filled with ‘the scent of the herbs they are burning against contagion’; the belief in the power of herbs to warn off infection, also referred to in Daniel Defoe’s Journal of a Plague Year, reflects the theory that diseases were caused by bad air. His wife slips in and out of consciousness – Cromwell hopes that if she survives the night she will recover, but she fades away towards dawn. Cromwell has to shut up his household, to prevent the spread of the disease beyond his door, a humiliation which adds to his grief.

According to the physician John Caius, who witnessed the final outbreak in 1578, the first symptoms were violent shivers, giddiness, headache and pains in the limbs. After this came sweat, intense thirst, and delirium. Finally, there would be exhaustion, collapse, and an urge to sleep. Some of these symptoms are compatible with plague, but there were none of the tell-tale swellings or skin discolouration. Death could occur within hours.

Bubonic Plague

Although often thought of as a factual account of the Plague epidemic of 1665, composed a few years after the event, Daniel Defoe’s A Journal of the Plague Year was actually written in 1722. As Defoe was only 5 years old at the time the book is set, it’s thought that much of the text is based on a diary kept by his uncle. He does go to great lengths to give an impression of realism, inserting tables of casualty figures into his account.

It’s easy to see why Journal was thought of as a true account. Defoe creates a sense of creeping dread. His protagonist chooses to stay in the city as the disease takes hold, watching helplessly as the death toll rises in the surrounding parishes. Looking at the figures, Defoe's narrator is, ‘filled... with serious thoughts of the misery that was coming upon the city, and the unhappy condition of those that would be left in it’. He discusses the measures taken to stop the spread of the disease, with local areas instituting unofficial quarantines (most notably in the Derbyshire village of Eyam, which secluded itself in a bid to prevent the spread of plague beyond its walls). In London, the Lord Mayor was forced to issue ‘certificates of health for such as travelled abroad’.

Defoe is particularly scornful of the attempts by Londoners to avoid infection. Unable to understand the spread of the disease, ‘the imagination of the people was turned wayward and possessed’, as they attempted to identify portents, such as a comet seen low over the city. In particular, Defoe singles out the mendacious ‘mountebanks’ and ‘quacking sort of fellows’, with their useless tonics and amulets designed to ward off the plague.

The plague of 1665 eventually killed around 100,000 people, or around 15% of London’s population. The Journal had a strange afterlife – in 1919, as Australia was hit by the Spanish Flu pandemic (which was often mistaken for plague by panicking reporters), a newspaper printed extracts from the book as a source of information on how to avoid infection. A later outbreak of the disease, in the Algerian city Oran in 1849, is thought to have inspired Albert Camus’ novel The Plague.

Spanish Flu

‘Death hath so many doors to let out life,’ said John Fletcher in The Custom of the Country, and in Kate Atkinson’s Life After Life, characters find themselves being ushered out of one door after another as the narrative charts the multiple possible strands of Ursula Todd’s life. Causes of death include drowning, stillbirth, shooting and bombing. One of the most terrifying possibilities, though, is the Spanish Flu which swept across the world in 1918. Fear of infection stops Ursula’s family from participating in the Armistice celebrations in London, and in one strand of the story, her young son succumbs to the disease.

In reality, the disease struck 18 – 25 year olds particularly hard, but all ages were affected, as the final death toll of between 50 – 100 million dwarfed the number of casualties from the war itself. It’s easy to see why it caused such terror. The disease moved quickly; John M Barry’s account of the pandemic, The Great Influenza, reports a series of anecdotes like that of Charles Lewis, a resident of Cape Town, who ‘boarded a streetcar for a three mile trip home when the conductor collapsed, dead. In the next three miles, six people aboard the streetcar died, including the driver.’ At this point, Lewis ‘stepped off the streetcar and walked home’.

The symptoms were often grotesque, with discolouration of the skin and bleeding from the ears, nose and eyes. Autopsies revealed that the condition of victims’ lungs were ‘reminiscent of lesions seen following inhalation of poison gas’. Victims were killed by a ‘cykotine storm’, an overreaction of the immune system to infection, which destroys healthy and infected cells alike. This is the reason for the high death toll among young, fit people – their stronger the immune system, the more damage it could cause.

As with any flu, infections spread rapidly in crowds, and many cities banned public assemblies, so Ursula’s family were wise to stay away from the celebrations in London. The disease was often mistaken for the bubonic plague, due to its rapid progress and symptoms, while it has also been linked to the concurrent epidemic of encephalitis lethargica. Other accounts of the pandemic occur in Katherine Anne Porter’s Pale Horse, Pale Rider, and Mary McCarthy’s Memories of a Catholic Girlhood, whilst Christopher Isherwood compared the feeling in Berlin after the Nazis’ rise to power in 1933 to the experience of living through the disease: ‘the whole city lay under an epidemic of discreet, infectious fear. I could feel it, like influenza, in my bones’. In fact, John M Barry also makes a somewhat speculative link between the Spanish Flu and the rise of Fascism, blaming Woodrow Wilson’s possible brush with the disease for his eventual capitulation to French demands for the humiliating Treaty of Versailles in 1919.

Encephalitis Lethargica

In the wake of the Spanish Flu came another, less well known, epidemic. Encephalitis lethargica, also known as the ‘sleeping sickness’, left victims in a coma-like state; other symptoms included vocal tics, muscle spasms, and behavioural changes including psychosis. Although the first cases were reported around 1915, the majority occurred between 1918 – 1926. Isolated cases have been identified since, but not in any significant numbers. The causes of the disease are still mysterious. John M Barry states that ‘no pathogen was ever identified and the disease itself has since disappeared – indeed, there is no incontrovertible evidence that the disease, in a clearly definable scientific sense, ever existed.’ He suggests that the outbreak may have been linked to the effects of the influenza virus on the brain, arguing that ‘physicians at the time did believe in the disease, and a consensus considered it the result of influenza’. This has since been called into question, however.

In his 1973 book Awakenings, the psychologist Oliver Sacks discussed the use of anti-Parkinsons drugs like L-DOPA in the treatment of long-term encephalitis sufferers. The fact that treatments were still being developed half a century after the epidemic shows the long-term effects of the disease. However, the effects of this treatment tended to be short-lived. Awakenings inspired Harold Pinter’s play A Kind of Alaska (1982), as well as a significant plot strand in Will Self’s Booker Prize shortlisted novel Umbrella (2012).

Sacks frequently makes appearances in Self’s fiction, under the guise of Dr Zack Busner, a washed-up 70s TV psychologist. In Umbrella, he appears in his pomp, during the first round of successful L-DOPA trials, and later as an old man. His star patient is Audrey Death, a suffragette and munitions worker who was struck down by the disease in 1918, and has been in a comatose condition ever since. Apparently oblivious to the outside world, Audrey and her fellow sufferers endlessly repeat seemingly meaningless actions, going through the motions of typing, or performing tasks on a production line. Busner learns to communicate with the patients by filming them, and watching their repetitive actions in slow motion, identifying, for example, ‘a flirtatious gesture that it took her two hours and twenty minutes to make’.

In Self’s prose, the unconscious, repetitive tics which Audrey and her fellow ‘enkies’ perform are analogous to the nervous jerks seen in films of the shell-shocked victims of trench warfare. The association between the frantic pace of modern life, warfare and madness can also be found in postwar novels such as Evelyn Waugh's Vile Bodies ('we were all driving round and round in a motor race, and none of us could stop... and we kept crashing and crashing') and in the wartime paintings of artists such as Gertler (see The Merry-Go-Round, 1916); all these examples represent modern life as a frantic whirligig which none of us can get off.

Ultimately, the benefits of L-DOPA treatment were short-lived. Current theories suggest that Encephalitis Lethargica may have been caused by an immune reaction to throat infections. Steroids and sleeping pills have both been suggested as possible treatments.